JAMA Ophthalmology Clinical Challenge: In the Context of Cic
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A woman in her 60s with a history of hypothyroidism presented with a 6-month history of progressive, diffuse redness and tearing in the left eye. She maintained a healthy diet and denied any history of malnutrition, gastrointestinal procedures, recent ocular infections, or chemical exposures. Her ocular history was notable for cataract extraction with intraocular lens implantation in both eyes. Shortly after cataract surgery in the left eye, performed 1 year prior to presentation, the patient developed cystoid macular edema treated with a sub-Tenon injection of triamcinolone acetonide. Ocular hypertension was noted after corticosteroid treatment, and the patient started brimonidine-timolol drops twice daily in the left eye.

At presentation, the patient’s corrected distance visual acuity was 20/20OD and 20/60 OS. She denied diplopia. Results of slit-lamp examination revealed a very mild shortening of the fornix inferonasally in the right eye. She had extensive keratinization of her conjunctiva in the left eye from the 3-o’clock to 10-o’clock positions with mild underlying hyperemia, with neovascular fronds at the superior corneoscleral limbus and extensive shortening of the inferior fornix. This case demonstrates an atypical presentation of ocular surface squamous neoplasia. The bilateral cicatrizing disease prompted workup for other underlying conditions, such as vitamin A deficiency and ocular cicatricial pemphigoid. s patient was treated with topical and subconjunctival injections of interferon alfa-2b, resulting in complete resolution of the OSSN within 2 months. The decision was made to closely monitor the patient for cicatricial disease progression in lieu of initiating treatment owing to the significant improvement with current therapy

Source: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2769752