Conjunctival Papilloma Differences from Malignant Eye Diseases

In the conjunctiva, papillomas, fibromas, hemangiomas, lymphangiomas, lymphomas, cysts, pigment and non-pigment birthmarks can develop. Papillomas can be observed in the first two decades of life in the form of multiple translucent reddish nodules, often localized on the lower fornix of the conjunctiva, their surface is bleeding from the slightest touch. Older patients have keratinous papilloma, located near the limbus and extending to the cornea.

These tumors are observed relatively rarely, they occur in 1.8-14% (most often in 5-9%) of all tumors of the organ of vision. The above neoplasms of the eyelids also develop in the conjunctiva. Only a few of them have their own peculiarity due to the topographic, anatomical and embryological development of the conjunctiva. In most cases, patients early turn to ophthalmologists, since these tumors are constantly subjected to friction and irritation of the eyelids, pressure, and the effect of tear fluid, especially with closed eyelids.


Main Features of Conjunctival Papillomas

Papillomas often come from epithelial tissue (various structures of papilloma, etc.). They usually occur in the zone of transitional epithelium in the area of the limbus. According to statistics, 51 out of 80 epithelial tumors of the conjunctiva and the cornea came from the limbus while there are 57 benign tumors and 23 are malignant.


According to morphological and clinical symptoms, papillomas are divided into:


  • keratinizing
  • non-keratinizing


The former, having arisen most often in the region of the limbus or the mucous membrane of the eyeball, can grow either in the direction of the cornea (with a broad base) or towards the conjunctiva of the eyeball (on the narrow stem).


The papillary hyperplasia of the epithelium is characteristic of the cornifying papilloma; the spinous layer develops and its thickness increases significantly. The color of such papillomas is grayish-white and they look like pearl-white growths, which is caused by the macerating effect of tears and the pressure of the eyelids.


Symptoms of Squamous Papilloma Conjunctiva

Papillomas protrude 2-3 mm above the surface, and their papillae are almost indistinguishable. For detailed study, you need to attract biomicroscopy and morphological methods of research. A pronounced vascular response is determined around the neoplasm. Very often, papilloma is accompanied by chronic conjunctivitis, supported by infection of the macerated surface of the tumor and desquamation of epithelial scales in the conjunctival cavity. Horny papilloma is difficult to distinguish from cancer; The diagnosis is made mainly on the basis of microscopic examination of the tumor. Cases of the malignancy of papilloma conjunctiva have been described, mainly for patients who have refused treatment. It should be emphasized that the horny papilloma of the conjunctiva is very similar in clinical picture to Bowen’s disease, and they can only be distinguished by means of histological examination.


The nonthorogenic papilloma of the conjunctiva, unlike the previous form of papilloma, is usually localized in the area of the lunate and transitional folds; phenomena of keratinization is not observed. Due to abundant vascularization, these papillomas have a reddish color. Papillary growths have thin legs. The texture of the papillomas is soft, they bleed easily when touched, reminding these angiomas. It is often accompanied by conjunctivitis.



How Do Papillomas on Conjunctiva Differ from Other Diseases?

Malignancy is very rare. Sometimes non-keratinous papilloma has a primary multiplicity on the conjunctiva, and at the same time warts on the skin of the hands and laryngeal papillomatosis develop. Differential diagnosis between papillomas and cancer, as well as other processes is carried out mainly on the basis of histological examination. Of the precancerous processes of the conjunctiva, diseases such as leukoplakia, xeroderma pigmentosa and Bowen’s disease, which are also rare, should be kept in mind.


Pigmented benign tumors of the conjunctiva — nevi — are not histologically distinguished from eyelid nevi. In the area of the conjunctiva, a borderline and mixed type of nevus is also usually observed (rarely, blue nevus, congenital melanosis of the conjunctiva). Among benign tumors of the conjunctiva, nevi make up about 1/3 of the neoplasms.


They usually arise at the limbus, less often in the area of the lunate fold and lacrimal caruncle. Nevi of the conjunctiva have a semi translucent appearance, due to the characteristic development of cysts in them. In about 1/3 of cases, they are pigmented and look like pinkish-yellow formations. In the remaining 2/3 of the observations, the pigment content is different. Patients are usually treated when the nevi are small, but sometimes there are large nevi that occupy the conjunctiva of the entire eyeball. In general, the clinical manifestations of conjunctival nevi are characterized by extreme diversity, due to their size, localization, pigmentation, vascularization, and reactive epithelial growths. It is noted that conjunctival nevi are more often malignized than eyelid nevi.


Among the pigmented tumors with localized growth emit precancerous melanosis of the conjunctiva and progressive nevus. They are rarely observed, but due to the frequent development of melanoma in these neoplasms, special oncological alertness must be manifested.


According to the research, among 61 patients with melanoma of the mucous membrane of the eye, 28.4% developed from precancerous melanosis and 40.5% on the basis of a nevus. The precancerous melanosis of the conjunctiva in its clinical course is characterized by diversity and duration. Usually flat diffuse pigmentation extends over a considerable length of the conjunctiva of the eyeball and eyelids. Observations of spontaneous regression of melanosis are described but malignancy is more common (28–80%): tumor nodules develop on a flat, pigmented surface.


What to Do If You Have a Papilloma on Conjunctiva?

In case, you have noticed some growths on your conjunctiva do the following. First, have the surveys:

  • External examination
  • Visometry
  • Perimetry
  • Biomicroscopy
  • Ophthalmoscopy


Mandatory laboratory tests include:

  • Complete blood count
  • Urinalysis
  • Blood on RW
  • Blood sugar
  • Hbs antigen


If you are diagnosed with conjunctival squamous papilloma, then the surgical removal of the tumor with the addition of cryotherapy is recommended. For relapses, local beta irradiation is used. Considering the multifocal nature of the lesion, surgical treatment may be ineffective, therefore laser evaporation (CO-2) or application of mitomycin 0.04% solution is indicated. Horny papilloma is subject to laserasexia.  A professional ophthalmologist will choose the best conjunctival papilloma treatment method taking into account the stage of the disease.

Автор: Brandith Irwin

Brandith Irwin is a board-ensured dermatologist and originator of Madison Skin and Laser Center in Seattle.

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