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A Novel Clinical Manifestation

Dalia G. Said, MD, FRCS; Manu Mathew, MSc, DipNB, MNAMS, FRCOphth, FRCS; M. Yusuf Shaikh, FRCS; V. Senthil Maharajan, MD, FRCS; James Lowe, FRCPath, PhD; Harminder S. Dua, MBBS, DO, DO(Lond), MS, MNAMS, FRCSEd, FRCOphth

Arch Ophthalmol. 2008;126(9):1226-1232.

Objective  To report a previously unrecognized benign bilateral widespread conjunctival and corneal proliferative condition with a potential to affect vision.

Methods  A gradually progressive diffuse conjunctival proliferation extending on the cornea was noted in 14 patients (28 eyes). These patients were followed up for a mean of 6 years for the site, extent, and progression of the condition. Six eyes had these lesions removed and studied histopathologically.

Results  Patients included 6 men and 8 women (mean age, 57 years). Two patients had bilateral nasal lesions only, 1 patient had bilateral temporal lesions only, 6 patients had both nasal and temporal lesions, and 5 patients had lesions that extended circumferentially. Pathology reports showed dense collagenous tissue, a moderate number of active fibroblasts, numerous blood vessels, and no elastotic degeneration in 3 of the 6 eyes. Two eyes showed mild subepithelial elastotic degeneration, and 1 lesion was difficult to interpret because of excessive intraconjunctival hemorrhage. None showed any inflammatory activity.

Conclusions  The lesions appear to be a clinical variant of classic pterygium with the corneal encroachment being wider, irregular, and more extensive. Histologically, a noninflammatory nonelastotic collagenous accumulation appears to be a predominant feature unlike in classic pterygium where elastotic degeneration is the predominant feature.

Author Affiliations: Divisions of Ophthalmology and Visual Sciences (Drs Said, Mathew, Shaikh, and Maharajan and Prof Dua) and Pathology (Prof Lowe), Queen's Medical Centre, University of Nottingham, Nottingham, England; and Research Institute of Ophthalmology, Cairo, Egypt (Dr Said).

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