The Catch Of The Day

Ocular surface neoplasia can develop due to various environmental and occupational factors, particularly among individuals with prolonged exposure to external elements such as chronic sun exposure. We report the case of a young fisherman diagnosed with corneal-conjunctival squamous cell carcinoma following prolonged UV exposure, emphasizing the importance of early recognition and management.

Case report of a fast growing ocular surface neoplasia diagnosed and treated in a tertiary-center.

A 38-year-old fisherman was referred to ULS S. João with corneal disorganization, fibrosis, stromal opacity, and 360º limbal neovascularization. He had a two-year history of progressive visual decline in the left eye (OS) and was considered a high-risk candidate for penetrating keratoplasty due to leucoma with deep neovascularization. The patient presented with worsening vision and a new whitish lesion in the OS. Biomicroscopy revealed a white, cauliflower-shaped elevated lesion covering the entire cornea, with extensive neovascularization, a large nasal stromal vascular trunk, limbal insufficiency, and brown pigmentation in the superior and inferior limbus. The lesion was excised at the Bowman membrane plane, followed by the application of mitomycin C. Histopathological analysis confirmed conjunctival intraepithelial neoplasia of high grade (carcinoma in situ). One week postoperatively, the patient’s best-corrected visual acuity (BCVA) was 0.05 logMAR, improving to 0.4 logMAR after two months of follow-up.

This case highlights the importance of early detection and surgical intervention in ocular surface neoplasia. Awareness and preventive strategies among outdoor workers may help mitigate the risk of such conditions, reinforcing the need for regular eye examinations and protective measures such as UV protection.