Conjunctival Lesions and Conjunctivoplasty
Derek W. DelMonte, MD
PREOPERATIVE CONSIDERATIONS
Children rarely have cancerous ocular surface and epibulbar growths; however, lesions can arise from many tissues in and around the ocular surface, and can be characterized as:
Epithelial
Melanocytic
Vascular
Fibrous
Lymphoid
The most common lesions in children are conjunctival nevi, which can range in pigmentation from nonpigmented to dark1,2 (Fig. 20.1).
In a retrospective case series of pediatric conjunctival tumors, Shields et al. reported that melanoma, compared with nevus, was associated with older age (>10-15 years), larger tumor, hemorrhage, and lack of cyst. The series showed lymphoma, compared with benign reactive lymphoid hyperplasia, was associated with larger size and diffuse involvement.
Preoperative documentation of conjunctival lesions is critical, and should include:
Size.
Shape.
Vascularity.
Growth pattern.
Involved tissues.
Color.
Solid vs cystic.
Perform a full conjunctival examination under the eyelids and into the fornix either intraoperatively or preoperatively to avoid missing satellite or second lesions.
 FIGURE 20.1. Conjunctival nevi can vary greatly in pigmentation. These are all examples of conjunctival nevi in children (Courtesy of Laura B. Enyedi, MD). A. Salmon-colored conjunctival nevus in an 11-year-old Caucasian child. B. Conjunctival nevus with intermediate pigmentation. C. Darkly pigmented conjunctival nevus in a 6-year-old African American child. |
Slit lamp photographs are most helpful and aid in following suspicious lesions and directing postoperative care.
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