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Published on: July 5, 2017
A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years
John Logan1, Ajay Mohite2, Oliver Kemp3
1Royal Victoria Hospital, Belfast Health and Social Care Trust, Northern Ireland, UK. johnlogan@doctors.org.uk.
Insights
Paediatric conjunctival lesions are rare but can threaten sight. Early detection and monitoring, especially for changing lesions, are crucial for timely diagnosis and management of these conditions.
Area of Science:
- Ophthalmology
- Paediatric Ophthalmology
- Oncology
Background:
- Paediatric conjunctival lesions are uncommon and varied, ranging from benign to sight/life-threatening.
- Optimal management hinges on recognizing concerning features of these lesions.
- This review provides insights into managing paediatric conjunctival lesions based on a 12-year case series.
Observation:
- A retrospective analysis of paediatric conjunctival lesions (2011-2022) in Belfast identified 85 cases.
- The cumulative incidence was 27 cases per 100,000 population.
- Common lesions included naevi (40%), limbal dermoids (21%), and conjunctival melanosis (14%).
Findings:
- Mean age at presentation was 7 years.
- At initial presentation, 8% required immediate surgery, 28% were discharged, and 64% were observed.
- Rare cases included a congenital intrascleral cyst, embryonal rhabdomyosarcoma, and a caruncular granuloma.
Implications:
- Paediatric conjunctival lesions can cause visual impairment and, rarely, malignant transformation.
- Anterior segment photography is vital for monitoring lesion changes and enabling early discharge.
- Histological diagnosis is essential for changing lesions to prevent potentially sight- and life-threatening outcomes.
Background:
Paediatric conjunctival lesions are rare and diverse. Though often indolent and asymptomatic, they can in some cases be sight or life-threatening. Awareness of concerning features of conjunctival lesions is key to optimal management. We aim to provide insight into management of paediatric conjunctival lesions though a review of cases in our service in last 12 years.
Methods:
We present a retrospective analysis of our population-based cohort of children with conjunctival lesions presenting to our regional service in Belfast between 2011 and 2022 inclusive. We detail three rare cases of paediatric conjunctival lesions; a congenital intrascleral cyst leading to astigmatic amblyopia, a rapidly changing salmon-pink lesion confirmed as an embryonal rhabdomyosarcoma and an unusual presentation of a chronic granuloma arising from the caruncle.
Results:
85 conjunctival lesions were identified in <16 year olds giving a cumulative incidence of 27 cases per 100,000 population over 12 years. Mean age at presentation was 7 years old. Most common lesions were naevi (40%), limbal dermoids (21%), conjunctival melanosis (14%), conjunctival cysts (7%) and phlycten (6%). When seen at presentation 8% of cases were immediately listed for surgery, 28% were discharged and 64% entered a phase of observation.
Conclusion:
Paediatric conjunctival lesions have potential to cause visual manifestations, whilst some may undergo malignant transformation. Anterior segment photography is crucial in monitoring change and facilitating early discharge in the absence of sinister features. Malignant transformation must be considered in changing lesions which ought to have histological diagnosis obtained to prevent potentially sight and life-threatening conditions.
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