Primary benign conjunctival tumors (nevi, dermoids, lymphangiomas, hemangiomas, lipomas, and fibromas) occur frequently, as do tumor-like inflammatory changes (viral papillomas, granulomas such as suture granulomas after surgery to correct strabismus, cysts, and lymphoid hyper-plasia). Malignant conjunctival tumors (carcinomas in situ, carcinomas, Kaposi’s sarcomas, lymphomas, and primary acquired melanosis) are rare. Benign lesions may become malignant; for example, a nevus or acquiredmelanosis may develop into a malignant melanoma. This section presents only the most important tumors.
Epibulbar dermoid is a round dome-shaped grayish yellow or whitish con-genital tumor. It is generally located on the limbus of the cornea, extendinginto the corneal stroma to a varying depth. Epibulbar dermoids can occur as isolated lesions or as a symptom of oculoauriculovertebral dysplasia (Golden-har’s syndrome). Additional symptoms of that disorder include outer ear deformities and preauricular appendages (Figs. 4.19a and b). Dermoids can contain hair and minor skin appendages. Ophthalmologists are often asked to remove them for cosmetic reasons. Surgical excision should remain strictly superficial; complete excision may risk perforating the globe as dermoids often extend through the entire wall of the eyeball.
Conjunctival hemangiomas are small, cavernous proliferations of blood ves-sels. They are congenital anomalies and usually resolve spontaneously by the age of seven. Where this is not the case, they can be surgically removed (Fig. 4.20).
Conjunctival cysts are harmless and benign. Occurrence is most often post-operative (for example after surgery to correct strabismus), post-traumatic, or spontaneous. They usually take the form of small clear fluid-filled inclu-sions of conjunctival epithelium whose goblet cells secrete into the cyst and not on to the surface (Fig. 4.21). Cysts can lead to a foreign-body sensation and are removed surgically by marsupialization (removal of the upper half of the cyst).
Papillomas are of viral origin (human papillomavirus) and may develop from the bulbar or palpebral conjunctiva. They are benign and do not turn malig-nant. As in the skin, conjunctival papillomas can occur as branching pediculate tumors or as broad-based lesions on the surface of the conjunctiva (Fig. 4.22). Papillomas produce a permanent foreign-body sensation that is annoying to the patient, and the entire lesion should be surgically removed.
Conjunctival carcinomas are usually whitish, raised, thickened areas of epithelial tissue whose surface forms a plateau. These lesions are usually ker-atinizing squamous cell carcinomas that develop from epithelial dysplasia (precancer) and progress to a carcinoma in situ (Fig. 4.23). Conjunctival carci-nomas must be excised and a cytologic diagnosis obtained, and the patient must undergo postoperative radiation therapy to prevent growth deep into the orbit.