Ocular surface squamous neoplasia In eye

1. Ocular Surface Squamous
Neoplasia (OSSN)
Clinical Overview and Case Scenarios
Eye Conference Presentation

2. Overview of OSSN
• Spectrum of conjunctival and corneal
epithelial neoplasia
– Ranges from dysplasia to invasive carcinoma

3. Epidemiology
• Incidence higher in tropical regions
– Associated with UV exposure and
immunosuppression

4. Risk Factors
• UV-B radiation
– HPV infection
– HIV/AIDS
– Chronic irritation, exposure to dust or chemicals

5. Pathogenesis
• Dysplastic changes in limbal stem cells
– Mutations in p53 and loss of heterozygosity

6. Clinical Spectrum
• Conjunctival intraepithelial neoplasia (CIN)
– Carcinoma in situ
– Invasive squamous cell carcinoma

7. Diagnosis
• Slit-lamp findings: gelatinous, papilliform,
leukoplakic lesion
– AS-OCT shows epithelial thickening and hyper-
reflectivity

8. Histopathology
• Dysplasia limited to epithelium in CIN
– Stromal invasion in SCC
– Positive immunostaining for cytokeratin

9. Differential Diagnosis
• Pterygium
– Pinguecula
– Limbal dermoid
– Papilloma

10. Case 1: Limbal OSSN – Presentation
• 45-year-old male, chronic sun exposure
– Limbal gelatinous mass with feeder vessels

11. Case 1: Management & Outcome
• No-touch excision with cryotherapy
– Topical IFN-α2b post-op
– No recurrence at 12 months

12. Case 2: Diffuse/Recurrent OSSN –
Presentation
• 60-year-old female, prior MMC therapy
– Diffuse conjunctival thickening

13. Case 2: Treatment & Follow-up
• Topical IFN-α2b and 5-FU combination
– Partial regression at 6 months
– Stable at 1-year follow-up

14. Medical Management
• Topical agents: IFN-α2b, 5-FU, Mitomycin-C
– Used for primary or adjuvant therapy

15. Surgical Management
• No-touch technique
– Alcohol epitheliectomy
– Cryotherapy at margins

16. Recent Advances
• AS-OCT for margin assessment
– Topical immunotherapy as first-line in selected
cases

17. Prognosis
• Recurrence 5–15% with adequate margins
– Prognosis excellent if early diagnosed

18. Summary
• OSSN is a treatable ocular surface malignancy
– Early recognition and multimodal therapy improve
outcomes

19. References
• Shields CL et al. Ophthalmology. 2024.
– Karp CL et al. Cornea. 2023.
– American Academy of Ophthalmology Updates
2025.