Objective: To describe three cases of squamous cell carcinoma of the conjun
ctiva presenting with corneal and scleral inflammation, thinning, and perfo
ration without any tumor formation.
Design: Three case reports.
Participants: Three male subjects aged 76, 66, and 61 years.
Intervention: The subjects had symptoms of external ocular inflammation wit
h focal corneal or scleral thinning and inflammation, as well as interstiti
al keratitis in two cases. Initial diagnosis of sclerokeratitis with limbal
thinning was made in all three in addition to a pterygium in case 2.
Main Outcome Measures: Diagnosis of the carcinoma was delayed for 2 to 24 m
onths in two cases, whereas case 2 was diagnosed on excision of a pterygium
from the involved area.
Results: All subjects developed intraocular extension after further scleral
thinning and perforation without tumefaction.
Conclusions: Squamous cell carcinoma of the conjunctiva may be seen without
a distinct mass and can masquerade as sclerokeratitis, scleromalacia, or i
nterstitial keratitis. It seems that diffuse growth with inflammation leads
to thinning, necrosis, and perforation of the ocular wall with resultant i
ntraocular spread. Squamous cell carcinoma should be considered in the diff
erential diagnosis of corneal and scleral thinning, perforation, and inflam
mation of unknown cause, especially in the older male subject. (C) 2001 by
the American Academy of Ophthalmology.