Giant Conjunctival and Caruncular Papillomas Causing Functional and Cosmetic Morbidity

A 51-year-old man presented with bilateral conjunctival and caruncular papillomas, protruding out medially and causing significant functional and cosmetic morbidity. He first developed the lesions 4 years ago. They grew gradually and became more symptomatic, causing itching, tearing, and sharp, stabbing pain. On exam, there were multifocal exophytic large papillomatous lesions emanating from each caruncle (Fig. 1A), diffuse bulky involvement of the left lower eyelid (Fig. 1B), and also diffuse involvement of each upper eyelid tarsal plate (not shown). The patient tested negative for HIV and denied a known history of human papillomavirus infection. The patient had excision of the exophytic component of the lesions medially, significant debulking of the left lower eyelid palpebral lesion, and multiple biopsies of upper eyelid tarsal lesions. A pathology review of all the specimens showed squamous papillomatous proliferation with focal mild cytologic atypia and no carcinoma present. The patient was further treated with 4 cycles of topical 5-fluorouracil chemotherapy in each eye. During a follow-up visit, the patient reports the resolution of all symptoms and is pleased with the functional and esthetic improvement of OU (Fig. 2A, B, C). There were some residual lesions in the left medial upper and lateral lower eyelid tarsal conjunctiva (Fig. 2D, E) that are being observed.FIG. 1FIG. 2