The 1998 Pan American Lecture - Intraocular invasion of conjunctival squamous cell carcinoma in five patients

Purpose: To report five patients with intraocular invasion of conjunctival squamous cell carcinoma and to make recommendations regarding clinical reco gnition and treatment of this condition. Methods: The authors reviewed the clinical records and pathology slides on five patients who had intraocular invasion of conjunctival squamous cell ca rcinoma, and they describe the presenting features and histopathology in th ese cases. Results: Intraocular invasion of conjunctival squamous cell carcinoma occur red in older patients who had one or more recurrences of a previously excis ed conjunctival epithelial tumor located near the corneoscleral limbus. The intraocular recurrence often was heralded by the onset of low-grade inflam mation and secondary glaucoma, simulating a granulomatous iridocyclitis. A white mass generally was observed in the anterior chamber angle. Histopatho logic examination revealed an ingrowth of malignant epithelial cells throug h the limbus with diffuse involvement of the anterior segment of the eye. T he reported patients were managed by modified enucleation (standard enuclea tion with excision of affected conjunctival tissue). Metastatic disease did not develop in any of the patients. Conclusions: The onset of signs of uveitis and glaucoma and a white mass in the anterior chamber angle in a patient with prior excision of a conjuncti val squamous cell neoplasm tumor should raise suspicion of intraocular recu rrence of conjunctival squamous cell carcinoma. Most affected patients requ ire enucleation or subtotal orbital exenteration. The prognosis is good.