AS-OCT Differentiates Conjunctival Papilloma From Cancerous Counterpart

AS-OCT can be used to differentiate conjunctival papilloma from papilliform ocular surface squamous neoplasia.

Differentiating features, detectable upon anterior segment-optical coherence tomography (AS-OCT) assessment, can distinguish conjunctival papilloma from  papilliform ocular surface squamous neoplasia (OSSN), according to a study published in Eye.

Researchers retrospectively reviewed chart data from individuals who were diagnosed with conjunctival papilloma (n=10; 70% men; mean age, 58.3 years) or papilliform OSSN (n=10, 60% men; mean age, 68.8 years) based on biomicroscopic evaluation. All participants underwent AS-OCT and provided demographic information. The research team compared structural and functional features between patients with the 2 diagnoses and graded AS-OCT images for the presence of epithelial hyperreflectivity, a corrugated epithelial surface, overhanging edge, intrinsic space, posterior shadowing and abrupt transition.

Patients with conjunctival papilloma had a thicker maximum epithelial thickness (936 vs 637 µm; P =.009), and were more likely to have a corrugated epithelial surface (70% vs 10%, P =.02), intrinsic spaces (100% vs 50%; P =.03) and posterior shadowing (100% vs 40%, P =.01) compared with individuals with OSSN. The lesions involved the limbus and bulbar conjunctiva in 80% and 100% of patients with OSSN, respectively, compared with a limbal and conjunctival involvement of 10% and 20%, respectively, in patients with papillomas. The most distinguishing feature was an overhanging edge in which the epithelial lesion was observed on top of the underlying epithelium (conjunctival papilloma: 100% vs OSSE: 0%; P <.001). 

These findings can be added to the armamentarium of AS-OCT features that can help clinicians diagnose ocular surface lesions.

“[O]ur study examined AS-OCT features of conjunctival papilloma and found several that differentiated papilloma from OSSN. Foremost, an overhanging, “mushroom” like edge was the key distinctive feature of papilloma that was not seen in OSSN,” according to the researchers. “These findings can be added to the armamentarium of AS-OCT features that can help clinicians diagnose ocular surface lesions.”

Study limitations include a small sample size, failure to obtain histological confirmation for all patients, and the technical limitations of the AS-OCT.


Sripawadkul W, Khzam RA, Tang V, et al. Anterior segment optical coherence tomography characteristics of conjunctival papilloma as compared to papilliform ocular surface squamous neoplasia. Eye (Lond). Published online November 19, 2022. doi:10.1038/s41433-022-02309-7