Giant mass conjunctival rhinosporidiosis causing severe mechanical ectropion

Area of Science:

• Ophthalmology
• Infectious Diseases
• Mycology

Background:

• Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, an organism of uncertain taxonomic classification, often linked to fungal pathogens.
• While typically affecting the nasal and nasopharyngeal mucosa, it can manifest in other mucous membranes and the skin, with ocular involvement termed oculosporidiosis.

Observation:

• A 50-year-old male agriculturist presented with a year-long history of a progressively enlarging mass protruding from the palpebral fissure.
• The mass, originating from the inferior bulbar conjunctiva, exhibited characteristics of chemosis, necrosis, hemorrhage, and keratinization, leading to mechanical ectropion.
• Recurrent redness, watering, and discharge were noted, consistent with ocular surface inflammation.

Findings:

• The conjunctival mass was diagnosed as rhinosporidiosis, a condition with a known predilection for agricultural workers, suggesting exposure to contaminated soil as a potential causative factor.
• Microscopic examination revealed typical features of rhinosporidiosis, confirming the presence of the causative agent within the conjunctival tissue.

Implications:

• Radical surgical excision combined with thermal and chemical coagulation is the primary treatment, though recurrence is common.
• Current medical treatments, including antifungals like griseofulvin and amphotericin B, have shown limited efficacy in managing rhinosporidiosis.
• This case underscores the importance of considering rhinosporidiosis in the differential diagnosis of conjunctival masses, particularly in individuals with occupational exposure to soil.