Invasive Ocular Surface Squamous Neoplasia Masquerading as Nodular Scleritis

Abstract

The authors report a rare case of ocular surface squamous neoplasia with intraocular involvement that had an initial masquerade presentation of recurrent anterior nodular scleritis. A 35-year-old male patient presented with right eye recurrent anterior nodular scleritis for which a lamellar patch graft was done. Two months later, the patient presented with recurrence of symptoms. Histopathology review revealed the presence of well-differentiated squamous cell malignancy. A high index of suspicion for malignancy is required in such cases when they do not respond to conventional therapy.

Ocular Surface Squamous Neoplasia with Intraocular Extension: Clinical and Ultrasound Biomicroscopic Findings

“…Clinical risk factors reported to be associated with IO extension in OSSN are previous surgical intervention [1,4,20], use of topical steroids [17,20], and nodulo-ulcerative pattern of OSSN [18]. In addition, thick nodular tumors, perhaps more than 5 mm, can also be taken as a risk factor for intraocular involvement, as seen in our study.…”

“…This may be considered as a characteristic of OSSN on UBM, as is also the presence of keratinization clinically when compared with other ocular surface tumors. OSSN-IO may mimic as necrotizing scleritis [16,17], orbital cellulitis [18], sclerokeratitis [13], or pterygium [4]. These varied presentations often lead to delay in diagnosis and inappropriate management, thus predisposing to the spread of the tumor to deeper tissues.…”

A prospective study of the incidence, associations and outcomes of ocular surface squamous neoplasia in the United Kingdom

“…The co-existence of different ocular surface diseases with OSSN has been described previously, and can present additional challenges for the diagnostic process [47][48][49]. OSSN has also been reported to masquerade as other ocular surface conditions [50][51][52]. Whilst histopathology remains the gold standard for diagnosis, it has been suggested that there might be a role for noninvasive imaging modalities, such as high resolution optical coherence tomography, in the detection and differentiation of OSSN from other ocular surface pathologies [47].…”

Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist

“…Though largely limited to case reports, neoplastic conditions like choroidal melanoma or undifferentiated carcinoma, conjunctival lymphomas, and ocular surface squamous neoplasia can masquerade as scleritis [186,[189][190][191]. Corticosteroid-resistant scleritis should prompt a scleral biopsy to investigate for neoplasia.…”