Ocular Surface Squamous Neoplasia Emerging During Autologous Serum Therapy: A Potential Role Of Growth Factors

To describe the clinical course of ocular surface squamous neoplasia (OSSN) diagnosed after initiation of autologous serum therapy in a patient with severe Sjögren-related dry eye, and to emphasize the need for careful ocular surface evaluation prior to biologic tear substitutes.

Tertiary referral center specializing in cornea and ocular surface disease.

Case report of a 76-year-old female with severe Sjögren-associated dry eye presenting with patchy keratitis and significant epithelial instability. Autologous serum eye drops were initiated for symptomatic relief. After six weeks of treatment, the patient reported worsening foreign body sensation and decreased visual acuity. Slit-lamp examination revealed conjunctival overgrowth with irregular epithelium extending from the nasal limbus toward the central cornea. In vivo confocal microscopy suggested epithelial dysplasia. Autologous serum was discontinued and topical interferon alpha-2b was initiated, followed by mitomycin C due to lack of response. Given progressive disease, anterior lamellar keratectomy with tumor excision was performed.

Histopathology demonstrated a 0.6 × 0.3 cm lesion with severe epithelial dysplasia involving approximately 75% of the epithelial thickness, consistent with conjunctival intraepithelial neoplasia. Initial surgical control was achieved and visual acuity improved to 20/60. However, the patient subsequently developed clinical limbal stem cell deficiency. Six months later, a persistent epithelial defect progressed to bacterial keratitis with hypopyon, ultimately requiring conjunctival flap coverage. Final visual acuity was limited to hand motion.

In eyes with severe Sjögren-related ocular surface disease, growth factor–rich biologic tear substitutes may unmask or accelerate the clinical expression of pre-existing epithelial dysplasia. Careful baseline and follow-up limbal assessment is essential to prevent delayed recognition of potentially aggressive neoplasia.