Histopathological Spectrum of Conjunctival Lesions at St John Eye Hospital

Abstract

Background: Various non-invasive modalities have been described in diagnosing conjunctival lesions but histology remains the gold standard. Shortages in ophthalmology services and pathology laboratories in non-urban areas is one of the main reasons for delayed presentation and appropriate treatment in sub-Saharan Africa. The purpose of this study is to determine the spectrum of histopathologic findings in conjunctival lesions from patients at St John Eye Hospital (SJEH). Materials and Methods: Data of patients who underwent conjunctival surgical biopsies was retrieved from the main theatre register of SJEH for a period of 3 years, starting from 1st November 2016 to 31st October 2019. This data was used to retrieve histology reports from National Health Laboratory Services (NHLS). Results: A total of 679 patient records were retrieved from the theatre register, only 585 histology reports from 584 patients could be analysed. There were 305 benign lesions with pterygia making up most of the benign lesions with a total of 249 (42.56%). A total of 174 premalignant lesions were recorded with severe ocular surface squamous neoplasia (OSSN) making up the bulk of premalignant lesions, 147/174(84.48%). Squamous cell carcinoma (SCC) was the main malignant lesion, 102 reported cases of a total 106 malignant lesions. The age ranged from 1 to 90 years with mean of 43.14 years. The patients were predominantly black, Caucasians constituted only 1%. The average age for SCC was 41.3 years, severe OSSN 43.6 and pterygia 46.3 years. Benign and premalignant lesions had a slightly higher predilection for females at 55.4% and 58.6% respectively. Males had a slightly higher predilection of malignancy at 54.7%. Conclusion: Pterygia are the most common excised benign conjunctival lesions and severe OSSN is the most common premalignant lesion excised at SJEH. SCC made up the bulk of conjunctival malignancies excised at SJEH. Pterygia, OSSN and SCC presents in a significantly younger age group when compared with reports from Europe, North and South America.