Effective Management of Recurrent Conjunctival Intraepithelial Neoplasia Using Topical Mitomycin C 0.02

Conjunctival intraepithelial neoplasia (CIN) is a premalignant lesion within the ocular surface squamous neoplasia (OSSN) spectrum that may recur after treatment and can progress to invasive squamous cell carcinoma (SCC) if left untreated. Management options include surgical excision, topical chemotherapeutic agents, immunotherapy, and radiotherapy in selected cases. A 64-year-old Egyptian man presented with a recurrent conjunctival mass in the right eye associated with irritation and discomfort. He had undergone surgical excision of a similar lesion at the same site 10 years earlier, with histopathological confirmation of CIN. Examination revealed a 6 × 7 mm raised, vascularized, irregular gelatinous lesion on the nasal conjunctiva, extending from the caruncle to the limbus with approximately 2 mm of nasal corneal epithelial involvement. The recurrent lesion was treated without current repeat surgical excision using topical mitomycin C (MMC) 0.02% in a cyclic regimen. Marked clinical regression was observed after four weeks. A second course was administered for a small residual lesion, resulting in complete clinical regression with mild localized scarring. The treatment was well tolerated, with only mild transient ocular discomfort, conjunctival injection, and tearing. The patient was followed for more than one year after treatment completion, with no documented clinical recurrence. This case suggests that topical MMC 0.02% may be an effective conservative treatment option for selected patients with recurrent CIN. Longer follow-up and larger studies are needed to confirm sustained efficacy, recurrence risk, and long-term safety.