Tumors Of The Ocular Surface: Bilateral Conjunctival Intraepithelial Neoplasia As Sentinel Manifestation Of Hiv Infection.

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR499 | Type: Poster | DOI: 10.82333/kcw2-9a96

Authors: Dr Jaime Losada Huelmos ¹ , Dr Hugo Santiago Balsera* ¹ , Dr Laura Modamio Gardeta ¹ , Dr Alba Luque Gómez ¹ , Dr Angel Sánchez Torres ¹ , Dr Miriam Buenasmañanas Maeso ¹

¹Hospital Universitario Infanta Cristina,Madrid,Spain

Purpose

To report the rare presentation of bilateral and synchronous conjunctival intraepithelial neoplasia (CIN) as a sentinel sign of primary HIV infection in a young patient. To highlight the need for systemic screening in light of this clinical finding, and to demonstrate the efficacy of combined management using surgical excision with a non-touch technique -touch technique and adjuvant topical chemotherapy to prevent recurrence in immunosuppressed patients.

Setting

Hospital Universitario Infanta Cristina. Department of opthalmology. Madrid, Spain.

Methods

We present the case of a 46-year-old man with a recent diagnosis of HIV who attended an ophthalmology clinic for assessment of a conjunctival lesion in his right eye, described as a mobile papillomatous vascular growth on the lower paralimbar
episclera.

The tumour was excised using a non-touch technique with 1.5 mm margins, double cryotherapy at the edges and amniotic membrane implantation. The pathological anatomy study of this first lesion confirmed a low-grade (grade 1/3) conjunctival intraepithelial neoplasia (CIN) with involvement of the resection margins.

Given this finding, adjuvant treatment was prescribed with four cycles of topical chemotherapy with 5-fluorouracil (5-FU) eye drops.

Results

During follow-up, a raised vascular lesion similar to the previous one was detected in the left eye. A non-touch excision technique was performed with 2 mm margins, cryotherapy and amniotic membrane grafting. The pathological anatomy diagnosis of this left eye again confirmed the presence of low-grade epithelial dysplasia, thus representing another low-grade CIN in the contralateral eye.

Given the exceptional nature of bilateral and synchronous squamous cell neoplasia of the ocular surface (OSSN) in a young patient, underlying immunodeficiency was suspected.

The multifocality acted as a sentinel sign, prompting a study of cellular immunity and serology, which confirmed a previously unknown primary HIV infection.

Conclusions

Bilateral conjunctival intraepithelial neoplasia (CIN) in a 46-year-old male is an exceptional clinical finding that acts as a sentinel marker of systemic immunosuppression.
In young patients, the synchronous or metachronous presentation of CIN is closely linked to HIV infection, in many cases being the first manifestation of the disease. The literature emphasises that HIV not only increases the incidence of these neoplasms, but also promotes more aggressive behaviour and higher recurrence rates.
Therefore, this case highlights the importance of HIV screening in the presence of bilateral lesions and justifies intensive therapeutic management to ensure control of the ocular surface.