Sclerokeratitis - An unusual presentation of squamous cell carcinoma of the conjunctiva

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.