Ocular Surface Squamous Neoplasia Masqueraders

To describe common ocular surface lesions that clinically mimic ocular surface squamous neoplasia (OSSN) and provide practical guidance for their accurate identification using anterior segment optical coherence tomography (AS-OCT).

We thoroughly reviewed various ocular surface lesions, categorizing them based on etiology. Diagnostic features on clinical examination, histopathology, and characteristic imaging findings on AS-OCT were critically assessed.

Numerous conditions can resemble OSSN, including corneal pannus, pseudopterygium, herpes simplex keratitis, conjunctival papilloma, trachoma, phlyctenulosis, pterygium, Salzmann nodular degeneration, conjunctival pyogenic granuloma, nevus, myxoma, schwannoma, Kaposi sarcoma, melanoma, lymphoma, sarcoidosis, and amyloidosis. Each of these lesions exhibits distinct imaging patterns on AS-OCT. OSSN uniquely demonstrates a hyperreflective thickened epithelium with a sharp transition between healthy and affected tissues, differentiating it clearly from other conditions.

Accurate diagnosis of OSSN versus its clinical masqueraders remains challenging. AS-OCT is an invaluable, non-invasive tool to support clinicians in reliably distinguishing OSSN, guiding informed management decisions, and appropriate use of biopsy.