Study links pterygium, ocular surface squamous neoplasia

Arch Ophthalmol. 2009;127(1):31-32.

All pterygium specimens should be submitted for histopathologic examination to identify any associated ocular surface squamous neoplasia at an early stage.

In a retrospective study examining 533 consecutive pterygium specimens excised from patients during a 5-year period, ocular surface squamous neoplasia was found in 52 of the specimens (9.8%). The researchers attribute the high rate of association to the common relation of both pathologies to sunlight exposure.

The same pathologist examined all specimens, and ocular surface squamous neoplasia was identified according to an accepted classification that includes mild, moderate and severe dysplasia, as well as carcinoma in situ.

In Queensland, Australia, a population-based study identified 1.9 new cases per 100,000 residents per year, although the researchers said this rate is thought to be a gross underestimate.

“Because both of these ocular surface conditions are strongly related to sunlight exposure, it could be expected that both might occur in the same individual,” the study said.

The take-home message of the article entitled “Pterygium and associated ocular surface squamous neoplasia” points out that with an incidence of 9.8% of biopsied ptergyia having dysplastic changes, it is important to send to pathology all pterygium specimens, which we have taken for granted. Although three cases had some clinical suspicion of dysplastic changes, others were not appreciated until pathology results came back. The relevance to my practice is to send all pterygium specimens for pathologic testing. Any reported dysplastic changes should be followed over a few years for recurrence.

- Mark R. Levine, MD, FACS

OSN U.S. Edition Oculoplastic and Reconstructive Surgery Section Editor