Three Cases of Papillomas Occurring on the Outer Eye

ABSTRACT

Papilloma is a benign epithelial tumor and may be divided etiologically into two types viral infectious and neoplastic; histologically the two types are indistinguishable. In the field of ophthalmology, Norris reported for the first time in 1879 that papilloma begins on the bulbar conjunctiva and spreads toward the cornea. Since then, many other cases of papilloma have been reported and these reports showed that it can occur on any portion of the epithelium of the external eye and has a predilection for sites where the epithelium undergoes a transition. We have seen three patients with papillomas a 6 year old girl with a papilloma on the caruncle; a 29 year old man, on the lower fornix; and a 42 year old woman, on the limbus. The caruncle and lower fornix papillomas were asymptomatic; the limbal papilloma was accompanied by foreign body sensation, epiphora, photophobia, and mild visual disturbance. On examination, the lesion on the caruncle was grayish-red; the surface was smooth with diffuse small red spots The lesion on the lower fornix was bright red, smooth surfaced, pedunculated, strawberry-like in appearance and showed papillary vascular proliferations. The margins of the limbal lesion extended to bulbar conjunctiva and cornea and the masswas firmly adherent to the cornea. The strawberry-like mass was grayish-white in color, hard, slightly elevated and showed papillary vascular proliferations. We feel that the papillomas on caruncle and lower fornix are viral infectious type and the one on the limbus is neoplastic type, based on the site of lesion, clinical symptoms and signs, and the age of the patient. The lesions of the above cases were removed by simple excisional biopsy and the one on the limbus also received post-excisional radiation treatment with Strontium 90. There has been no sign of complication in the four months of follow-up on the caruncle papilloma and two months of follow-up on the lower fornix and limbal papilloma.