Primary Globe-Sparing Treatment In Ocular Surface Mucoepidermoid And Adenosquamous Carcinoma: A Systematic Review Of The Literature.

Conjunctival mucoepidermoid carcinoma (MEC), recently reclassified as adenosquamous carcinoma (ASC), is a rare, locally invasive malignancy that can arise across the ocular adnexa, including the ocular surface. Given its tendency for local extension and recurrence, many historically reported ocular surface cases were primarily managed with enucleation or exenteration. However, due to the limited evidence base and heterogeneity in reported treatment strategies, outcomes after primary globe-sparing management remain incompletely defined. This systematic review evaluates the clinical outcomes and the feasibility of conservative, globe-preserving approaches in the treatment of ocular surface MEC and ASC.

Systematic synthesis of the published literature on ocular surface MEC and/or ASC managed initially with globe-sparing treatment modalities, identified through database searching and reference screening.

A systematic review was performed of all English-language records indexed in PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library, including screening of the first 100 records in Google Scholar, from inception through January 31^st, 2026. Eligible studies reported clinical outcomes for ocular surface tumors historically diagnosed as MEC and/or classified as ASC that were initially managed with globe-sparing modalities, including local surgical excision, topical medical therapy, radiotherapy, and or laser ablation.

19 studies met inclusion criteria, comprising 37 tumors in 37 patients. 23 tumors (62.16%) were historically reported as MEC and 14 (37.84%) as ASC. Patients were predominantly male (80.6%), and mean age was 63.9 years (33–89 ±12.6). Primary globe-sparing therapy included local excision without cryotherapy in 22 cases (59.5%), excision plus topical medical therapy in 4 (10.8%), excision plus radiotherapy in 4 (10.8%), excision with cryotherapy in 2 (5.4%), radiotherapy alone in 2 (5.4%), local IFNα2b therapy in 2 (5.4%), and laser ablation in 1 (2.7%). Recurrence occurred in 23 cases (62.16%) at a mean of 5.40 months. Globe preservation was achieved in 24 cases (64.9%), 12 (39.0%) required enucleation/exenteration and 1 was not reported.

Across published reports, primary globe-sparing management of ocular surface MEC and ASC achieves meaningful rates of globe preservation. However, recurrence remains common and frequently occurs within the first year. Although nearly two-thirds of eyes were ultimately preserved, a substantial proportion still required enucleation or exenteration, underscoring the locally aggressive behavior of these tumors and the need for close surveillance and timely escalation when local control is not achieved. Given the rarity of the disease and heterogeneity of reported management strategies, larger contemporary series with standardized reporting are needed to better define optimal globe-sparing treatment pathways.