Conjunctival tumors

What you need to know about ocular surface tumors

Anatomy

Anatomy

The conjunctiva is a mucous membrane that covers most of the ocular surface. It covers both the anterior part of the eyeball (sclera), except for the transparent part (cornea), and the inner surface of the eyelids in contact with the eyeball. The conjunctiva plays a particularly important role in maintaining corneal homeostasis, providing immune defense and maintaining a good quality tear film.

Conjunctival tumors are tumors located on the surface of the eye. These lesions are located in the visible part of the eye (bulbar conjunctiva), and can invade the cornea. In some cases, these lesions may appear under the eyelids (tarsal conjunctiva), and may not be immediately visible. The term tumor covers both benign and malignant (cancerous) tumors. Only cancers are discussed in this section.

Histology

Histology

The conjunctiva is a mucous membrane composed of an epithelium, which also contains mucus cells and melanocytes, resting on the chorion, composed of connective tissue cells, and separated by a basement membrane.

Any one of these cells can be the source of a conjunctival malignancy.

Main conjunctival tumors

There are three main categories of conjunctival cancer, depending on the cell of origin. Other cancers are much rarer.

Symptoms

The symptoms of ocular surface cancers are non-specific, meaning they can be found in other non-cancerous eye diseases. In most cases, these symptoms do not appear until the disease is in its late stages, and they are not always reason enough to seek medical advice.

Conjunctival pigmentation

Changes or appearance of pigmentation in the conjunctiva.

Nodule

A nodule or mass that appears pinkish or whitish may be visible directly to the naked eye or palpable under an eyelid.

Decreased vision

Decreased vision related to tumor invasion of the cornea.

Miscellaneous symptoms

More rarely, patients may experience visual discomfort, dry eyes or bleeding, but the causal link with conjunctival cancers has not always been established.

Management of conjunctival tumors

The treatment of a conjunctival tumor involves several procedures.

Surgery

The first stage of treatment involves surgical excision in an operating room, typically under general anesthesia. The entire tumor is removed and sent for analysis to confirm the suspected diagnosis.

Topical chemotherapy

Once the diagnosis has been confirmed, chemotherapy eye drops may be prescribed to reduce the risk of local recurrence, especially for early-stage cancer (in situ).

Radiotherapy

For confirmed cancers with a high risk of local or locoregional recurrence, radiotherapy is often recommended. This often involves proton therapy, a technique tailored to ocular tumors.