A Challenging Presentation Of Corneal Intraepitelial Neoplasia

To report an incidental and atypical presentation of corneal intraepithelial neoplasia (CIN), within the spectrum of ocular surface squamous neoplasia (OSSN), mimicking herpetic epithelial keratitis and to highlight diagnostic challenges and clues in isolated corneal lesions without limbal involvement.

Tertiary referral ophthalmology center providing routine clinical care, advanced anterior segment imaging, and surgical management of ocular surface disease.

Case report of a 72-year-old man presenting for routine ophthalmological examination. Clinical assessment, anterior segment optical coherence tomography (AS-OCT), serial photographic follow-up, and histopathological evaluation were performed.

The patient presented with a dendritiform keratotic epithelial lesion in the inferior temporal cornea without limbal involvement. Visual acuity was preserved, and AS-OCT confirmed epithelial confinement. Due to its dendritic morphology, herpetic epithelial keratitis was suspected and oral valaciclovir therapy was initiated without clinical improvement. Progressive enlargement with increasing corneal astigmatism was documented over 11 months. Corneal epitheliectomy with intraoperative mitomycin-C was performed, and histopathology confirmed CIN with diffuse p53 positivity. Postoperative evolution was favourable, best-corrected visual acuity remained preserved and no recurrence was observed at 9 months.

CIN may present as an asymptomatic dendritiform lesion closely resembling herpetic keratitis. Lack of therapeutic response and documented progression should prompt early reconsideration of diagnosis. Even isolated corneal epithelial lesions without limbal involvement should raise suspicion of ocular surface neoplasia. Timely diagnosis and appropriate surgical management allow favourable visual and clinical outcomes.