Growths And Pigments

Question 1

Difference between CIN and pinguecula

Answer 1

CIN has neovascularization

Question 2

Most common conjunctival malignancy in the US

Answer 2

CIN

Question 3

What is CIN

Answer 3

Unilateral, pre-malignant condition that can progress to a SCC (although the risk is low). Risk factors for development of CIN include UV-B exposure, fair skin, xeroderma pigmentosa, exposure to petroleum derivatives, HIV, and HPV

Appx 95% of cases are located on the limbus with inthe interpalpebral fissure, although it can progress onto the cornea. Although the presentation can vary, CIN commonly appears as an elevated gelatinous mass with neovascularization; 10% of cases exhibit leukoplakia (keratinization)

Question 4

What is conjunctival SCC

Answer 4

Rare and slow growing malignant tumor that are most common in elderly caucasian (90%) males (81%); it is associated with UV radiation and is most commonly derived from CIN. It is usually located at the limbus., contains a feeder vessel, and involves the cornea.

Limbus
Feeder vessels
Neo

Question 5

What is racial melanosis

Answer 5

Characterized by benign (no malignant potential), flat, patchy areas of conjunctival pigmentation that are most concentrated at the limbus. It is typically bilateral and asymmetric, and is most common in AA

Question 6

Difference between PAM and racial melanosis

Answer 6

PAM

• unilateral
• caucasian

Racial melanosis

• bialteral
• AA

Question 7

What is PAM

Answer 7

Rare, unilateral, acquired conjunctival pigmentation that us most common in elderly caucasians; it has pre-malignant potential and 30% of cases progress to malignant conjunctival melanoma. PAM results from the proliferation of intraepithelial melanocytes

• located anywhere on the conjunctiva and appears as flat patches of pigmentation with indistinct margins.
• nodular lesions with increased vascularity and/or increased growth are most suspect for potential malignancy. A biopsy is warranted to determine whether the lesion is malignant

Question 8

What is a conjunctival nevus

Answer 8

Rare, benign proliferation of melanocytes that presents around puberty and early adulthood (within the first 2 decades of life); typically unilateral, flat, or slightly elevated, freely mobile, and occasionally non pigmented (30%). It is not uncommon for the size and the darkness of the nevus to increase during puberty

Question 9

Most common location for conjunctival nevus

Answer 9

Juxtalimbal conjunctiva, followed by the plica and the caruncle. If a pigmented lesion is on the palpebral conjunctival, consider it PAM

Question 10

If a pigmented lesion is found on the palpebral conj, considered it

Answer 10

PAM

Question 11

What is diagnostic for conjunctival nevus

Answer 11

Inclusion cysts

Question 12

If a conjunctival nevus is located in a weird location

Answer 12

Cornea, fornices, etc

Biopsy

Question 13

Conjunctival lymphomas

Answer 13

Smooth ,fleshy, sub-conjunctival, salmon colored patches that typically occur in middle age adults. Prognosis caries depending on whether the lesion is benign (reactive lymphoid hyperplasia) of malignant (non Hodgkin’s lymphoma, mucosa associated lymphoid tissue (MALT))

Question 14

Pyogenic granuloma

Answer 14

Pedunculated, benign, fleshy, vascualr lesions of the palpebral conjucntiva that typically result from trauma (often vary minor), surgery, a chalazion, or other sources of chronic irritation. Typically grow very rapidly over a period of a few weeks to an average size of a half an inch

Question 15

Malignant melanomas of the conjunctiva

Answer 15

Secondary to uncontrolled proliferation of melanocytes
Almost exclusively in caucasians and typically develop around age 50
Pigmented or non pigmented
Most commonly arise from PAM (PAM, then nevus, then de novo, in order of most common to least common)

Question 16

The most important prognostic indicator for malignant melanoma of the conj

Answer 16

Thickness

Question 17

The most common site of metastasis of malignant melanoma of the conj

Answer 17

Liver

Question 18

Which is more likely to metastasis, malignant melanoma of conj or conjunctival SCC

Answer 18

Malignant melanoma

Question 19

The most common ocular side effect of phenytoin

Answer 19

Nystagmus

Question 20

Drugs that can cause cataract

Answer 20

Chlorpromazine (anterior stellate), amiodarone (anteiror subcapsular), miotics (vacuoles), gold salts (gold deposits), corticosteroids (PSC)

May Trigger Anterior Cataracts

• miotics
• thioridazine
• amiodarone
• chlorpromazine
• steroids
• gold salts

Question 21

Drugs that can cause nystagmus

Answer 21

Phenytoin (Dilantin), phenobarbital (Luminal), salicylates

Question 22

Drug that can cause BY color vision defects

Answer 22

Digoxin and viagra

Question 23

Treatment for CIN

Answer 23

Traditionally treated with surgical excision and supplemental cryotherapy, although anti-metabolites (MMC, 5-FU, interferon) are no also being used as treatment for CIN

Question 24

Treatment for PAM

Answer 24

Monitored every 6m with clinical documentation; lesions that become nodular, have increased vascularity, and/or increased growth are more suspect for potential malignancy. A biopsy should be performed to determine whether the lesion is malignant. Treatment involves surgical excision and cryotherapy

Question 25

Treatment for conjunctival lymphomas

Answer 25

Require tissue biopsy with immunohistochemical studies due to the wide spectrum of disease outcomes. If the lesion is malignant, external beam radiation of the conjunctival is indicated. Patients should also be referred for a systemic evaluation and possible systemic treatment of metastasis

Question 26

Treatment for pyogenic granuloma

Answer 26

Monitored, or if the patient is symptomatic, treated with topical abx/steroid combo (tobradex) or surgical excision

Question 27

Treatment of conjunctival nevi or racial melanosis

Answer 27

Do not require treatment. If the conjunctival nevus becomes a malignant melanoma, local excision with cryotherapy of the lesion is indicated

Question 28

Drugs that increase risk of retinal breaks or detachments

Answer 28

Pilocarpine and other miotics.