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 Table of Contents    
LETTER TO THE EDITOR
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 105-106  

Squamous papilloma of the eyelid margin: Lamellar division and cryotherapy


1 Oculoplastic and Pediatric Ophthalmology Services, All India Institute of Medical Sciences, Patna, Bihar, India
2 Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
3 Ocular Pathology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission02-Apr-2018
Date of Decision25-Nov-2019
Date of Acceptance08-Mar-2020
Date of Web Publication28-May-2020

Correspondence Address:
Gautam Lokdarshi
Oculoplastic and Pediatric Ophthalmology Service, All India Institute of Medical Sciences, Phulwari Sharif, Patna - 801 507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_47_2018

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How to cite this article:
Lokdarshi G, Pushker N, Kashyap S, Bajaj MS, Shameer A. Squamous papilloma of the eyelid margin: Lamellar division and cryotherapy. Oman J Ophthalmol 2020;13:105-6

How to cite this URL:
Lokdarshi G, Pushker N, Kashyap S, Bajaj MS, Shameer A. Squamous papilloma of the eyelid margin: Lamellar division and cryotherapy. Oman J Ophthalmol [serial online] 2020 [cited 2020 Oct 21];13:105-6. Available from: https://www.ojoonline.org/text.asp?2020/13/2/105/285302



Sir,

There is a grey zone of demarcation between squamous papilloma and squamous neoplasia of the ocular surface in regard to etiopathogenesis, treatment, and recurrence.[1] Multiple modalities have been described for the treatment of these squamous proliferations of the ocular surface, and among these, the role of excision with cryotherapy is well established.[2]

A 17-year-old girl presented with recurrent squamous papilloma of the left upper eyelid, after excision 3 months before. No previous biopsy report was available. On slit-lamp examination, squamous papilloma was involving the posterior lid margin and extending over the whole tarsoconjunctiva up to its upper border [Figure 1]a. Under frontal block, the lesion was shaved off with number 11 blade. Upper lid lamellar division was performed, and relaxing vertical cut was placed on each tarsal end extending up to upper border of the tarsus [Figure 2]. Cryoprobe (liquid nitrogen) was applied over the involved posterior lamella with double freeze-thaw technique. The durations for freezing and thawing were 20–30 s and 1–2 min, respectively. Frequent use of lubricating drop and gel was advised along with antibiotics and analgesics. No recurrence, epiphora, dry eye, or lid margin malposition was noted during the 1-year follow-up [Figure 1]b. Histopathology was suggestive of benign squamous papilloma [Figure 1]c.
Figure 1: (a) Recurrent squamous papilloma involving posterior lamella (tarsoconjunctiva) of the left upper eyelid; (b) no recurrence or lid malposition at 1 month postexcision with cryotherapy; (c) microphotograph showing benign squamous papilloma (H and E, ×40)

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Figure 2: Sketch showing cross-sectional view of the upper eyelid and the procedures performed

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Pathological evidence of malignant changes in clinically benign papilloma has been well documented in the literature.[1] Therefore, even though the clinical appearance of squamous papilloma was characteristic, we planned excision biopsy.

Multiple cycles of “rapid freeze-slow thaw” cryotherapy at the base of papilloma are essential to prevent its recurrence, especially in younger patients.[3] The challenge in such cases was lid margin and tarsus involvement limits its use because of risk of hair follicles loss, punctal atresia, skin depigmentation, symblepharon, lid malposition, transient conjunctivitis, and blepharitis.[4] Lamellar division before applying cryoprobe to the posterior lamella prevents cryo-induced damage to hair follicles and melanocytes of the anterior lamella. We believe that the two relaxing vertical cuts at the medial and lateral edges of the tarsus safeguard the lid against cicatricial entropion or punctual malposition due to postcryotherapy scarring. This also places punctum or canaliculus away from the site of cryoprobe application and thus prevents direct damage to them. Symblepharon usually does not occur if cryoprobe is used meticulously.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Doherty WB. Ocular papillomata. Am J Ophthalmol 1932;15:1016-21.  Back to cited text no. 1
    
2.
Harkey ME, Metz HS. Cryotherapy of conjunctival papillomata. Am J Ophthalmol 1968;66:872-4.  Back to cited text no. 2
    
3.
Wilkes TD, Fraunfelder FT. Principles of cryosurgery. Ophthalmic Surg 1979;10:21-30.  Back to cited text no. 3
    
4.
Bullock JD, Beard C, Sullivan JH. Cryotherapy of basal cell carcinoma in oculoplastic surgery. Am J Ophthalmol 1976;82:841-7.  Back to cited text no. 4
    
5.
Eichler MD, Fraunfelder FT. Cryotherapy for conjunctival lymphoid tumors. Am J Ophthalmol 1994;118:463-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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