This document discusses ocular surface squamous neoplasia (OSSN), a term that encompasses precancerous and cancerous epithelial lesions of the conjunctiva and cornea. Some key points: - OSSN accounts for 39% of all premalignant and malignant ocular surface lesions. Risk factors include ultraviolet light, immunosuppression, HPV infection, and smoking. - Diagnosis is usually based on appearance of a red, elevated mass with intrinsic vessels or feeder vessels. Advanced cases can infiltrate the cornea, sclera, or orbit. - Treatment involves surgical excision with clear margins followed by cryotherapy. Recurrence rates after surgery are over 50%

1. Ocular surface squamous
neoplasia
Dr.Ruchi sood
PG 2nd year,SSIMSRC

2. Introduction
• Tumors of the ocular surface have a wide clinical spectrum and include several
forms of epithelial, stromal, caruncular, and secondary tumors.

3. Epithelial tumors

4. • Ocular surface squamous neoplasia (OSSN) is an encompassing term
for precancerous and cancerous epithelial lesions of the conjunctiva
and cornea.
• Proposed by Lee and Hirst, (OSSN) includes the clinical continuum of
mild, moderate, and severe dysplasia, carcinoma in situ, and invasive
squamous cell carcinoma (SCC).
• CIN accounts for 39% of all premalignant and malignant lesions of the
conjunctiva.
• Ocular surface squamous neoplasia is mostly unilateral and is seen in
middle-aged and older patients

6. Etiology and Risk factors
 Ultraviolet light
 Immunosuppression/ HIV
 Human papillomavirus (HPV) 16
 Mutation or deletions of tumor suppressor gene p53
 Xeroderma pigmentosum and Papillon-Leferve syndrome
 Smoking
 Ocular surface injury(chemical)
 Chronic inflammatory conditions like- ocular pemphigoid,
blepharoconjunctivitis.
 Chemical exposure- trifluridine, arsenic beryllium

9. Diagnosis
• Patients are often unaware, may complain of redness and ocular irritation
secondary to inflammation.
• Leukoplakia is usually absent or minimal in CIN. The presence of feeder
vessels and intrinsic vascularity favors SCC.
• The tarsal conjunctiva should be examined after everting the eyelid of
patients with OSSN to detect contiguous or multifocal involvement of the
tarsal conjunctiva.
• Advanced cases can infiltrate the cornea and sclera to have the intraocular
extension.
• Rarely, the tumor may extend into the orbit causing proptosis. The tumor
can metastasize to the regional lymph nodes and rarely distant metastasis
may occur.

10. (a) Elevated nasal LIMBAL MASS INVOLVING THE CORNEA with abundant keratin
and feeder vessels.
(b) Pigmented variant seen as a NODULAR MASS.
(c) Diffuse, elevated, PAPILLIFORM LESION involving the entire ocular surface
with intrinsic vessels.
(d) GELATINOUS TYPE with episcleral feeder vessels.

11.  Oct
 Impression Cytology
 Rose Bengal Staining
 High Frequency Ultrasound
 Confocal Microscopy
 Biopsy

15. Pyogenic granuloma

17. Hereditary benign intraepithelial dyskeratosis
AD Elevated leukoplakic pink lesion in the temporal limbal area with apparent feeder
vessels and pigmentation.
Pterygium

18. Actinic keratosis A focal leukoplakic lesion seen in the interpalpebral are
Rose bengal

19. (a) Conjunctival nevus with intralesional cysts and feeder vessels.
(b) Microphotograph of a subepithelial nevus showing clumps of melanocytes with no
cellular atypia

20. CONJUNCTIVAL MELANOMA
(A) Elevated, nodular, pigmented mass at the inferior limbus with extension into the peripheral
cornea. Note the presence of feeder vessels and intrinsic vessels.
(B) Microphotograph of conjunctival melanoma showing variably pigmented melanocytes with
mitotic activity

21. CONJUCTIVAL LYMPHOMA
(a) Superior bulbar conjunctiva shows typical salmon pink mass with cork-screw
vessels
(b) Microphotograph of conjunctival lymphoma. Note the monomorphic appearance
of cells

22. TREATMENT
Topical chemotherapy
No-touch technique
cryotherapy

25. • Nodular lesion with abundant keratin at the limbus.
• Immediate postoperative appearance following complete excision with margin
clearance, double freeze cryotherapy and ocular surface reconstruction with
amniotic membrane transplantation with tissue glue.

30. PROGNOSIS
• The recurrence rate of OSSN after surgical excision can occur
in over half of cases and may occur years later.
• The rate of recurrence is substantially higher in the setting of
positive surgical margins. Even if the surgical margins are
negative, up to one- third of eyes may experience a
recurrence within 10 years.