Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and.
Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT.
Cornea. 2022 Sep 1;41(9):1185-1187. doi: 10.1097/ICO.0000000000002946. Epub 2022 Jan 26.
The purpose of this study was to report a unique case of ocular surface squamous neoplasia that masqueraded as a nonresolving toxic epithelial keratitis.
This was a case report and review of the literature.
A 79-year-old man presented with decreased vision, redness, and a foreign body sensation in his right eye that was refractory to treatment with lubrication and topical nonsteroidal antiinflammatory drops. Before presentation, the referring provider believed that he had medicamentosa-related keratitis and placed him on oral methazolamide. Slitlamp biomicroscopy of the right eye revealed diffuse epitheliopathy with punctate fluorescein staining and subtle underlying corneal epithelial opalescence. A mildly thickened and inflamed pinguecula was noted from 2 to 5 o'clock at the limbus of the right eye. An anterior segment high-resolution optical coherence tomography revealed thickened, hyperreflective epithelium with an abrupt transition. An incisional biopsy confirmed conjunctival and corneal intraepithelial neoplasia. The patient improved after 4 cycles of topical chemotherapy with 1% 5-fluorouracil eye drops with complete resolution of the corneal and conjunctival pathology.
Ocular surface squamous neoplasia can rarely masquerade as a recalcitrant medicamentosa and epithelial keratitis. In subtle cases or in cases with combined ocular surface morbidities, anterior segment high-resolution optical coherence tomography can be helpful to diagnose and direct therapy.
本研究旨在报告一例表现为迁延不愈的毒性上皮性角膜炎的眼表鳞状细胞上皮内瘤变。
这是一个病例报告和文献复习。
一名 79 岁男性因右眼视力下降、发红和异物感就诊，经润滑和局部非甾体抗炎滴眼剂治疗后无缓解。就诊前，转诊医生认为他患有与药物相关的角膜炎，并给他开了口服甲唑胺。右眼裂隙灯生物显微镜检查显示弥漫性上皮病，点状荧光素染色，轻微基底角膜上皮混浊。右眼 2 点至 5 点的角膜缘可见轻度增厚和炎症性翼状胬肉。眼前节高分辨率光学相干断层扫描显示上皮增厚、高反射，并有明显的过渡。经切开活检证实为结膜和角膜上皮内瘤变。该患者接受了 4 个周期的 1% 5-氟尿嘧啶眼药水局部化疗后，角膜和结膜病理完全缓解。
眼表鳞状细胞上皮内瘤变罕见地可表现为顽固的药物性和上皮性角膜炎。在轻微病例或合并眼表疾病的情况下，眼前节高分辨率光学相干断层扫描有助于诊断和指导治疗。
