Clinicopathological evaluation of secondary conjunctival pigmentations following enucleation

The aim of this study was to evaluate histopathologically the conjunctival pigmentations occurring in post-enucleation anophthalmic sockets and to identify the common causes.

Retrospective cohort study.

This was a retrospective chart review of patients who presented with conjunctival pigmentation in the anophthalmic socket at a single tertiary care center and who underwent incisional conjunctival biopsy between 2018 and 2022. Demographic and clinicopathological data, and treatment outcomes were retrieved.

A total of 14 consecutive patients aged between 17 and 70 years were enrolled. Indications for primary enucleations were: retinoblastoma in 5 (35.7%), uveal melanoma in 6 (42.8%) patients, ciliary body schwannoma in 1 (7.1%), retinal hemangioblastoma in 1 (7.1%) and endophthalmitis in 1 patient (7.1%). Histopathological diagnoses of conjunctival pigmentations were chronic inflammation in 9 (64.3%), recurrence of melanoma in 2 (14.3%), nevus in 2 (14.3%) patients and in situ squamous cell carcinoma in 1 (7.1%) patient.

Chronic inflammation was the most common cause of secondary conjunctival pigment deposits over the anophthalmic socket following enucleation. Still however, these pigmented spots should be approached judiciously as in overall 35.7% of the cases, and in 33.3% of uveal melanoma patients in particular, malignant or suspicious/precancerous lesions were encountered.