Quistes

Conjunctival inclusion cyst is a relatively common lesion that may be congenital or

acquired, the latter being more common.
The most frequent cause of a large acquired congenital cyst is the implantation of
conjunctival epithelium after surgery, trauma, or conjunctival inflammation.
Most conjunctival cysts can be treated adequately by simple excision.
Drainage alone is insufficient because fluid may accumulate again unless the cyst is
excised.

Papiloma
Squamous cell papillomas are benign tumors of the conjunctiva in which acanthotic
squamous epithelium covers fi brovascular cores.
Large tumors may cause foreign body sensation, irritation, bleeding, or be cosmetically
unacceptable.
A combination of the translucency of the conjunctiva, the presence of goblet cells within
the covering epithelium, and the central vascular core accounts for its characteristic
glistening surface.
HPV types 6, 11, 16, 18, and 33 have been associated with benign conjunctival papilloma.
Signs of dysplastic change include increased keratinization, inflammation of the adjacent
conjunctiva with symblepharon formation, and spread to the tarsal conjunctiva.
treatment is indicated for all symptomatic and asymptomatic conjunctival lesions that are
growing rapidly or not remitting spontaneously on careful follow-up.
The management of these squamous papillomas is difficult Although topical
chemotherapy, including interferon alpha and mitomycin C, has been proposed,36 simple
excision with cryotherapy to the base and surrounding epithelium remains the most
effective treatment.
When these lesions are treated, it is important to excise the lesion with an adequate
surrounding area of normal conjunctiva at the base, because recurrences are frequent,
particularly in children.
These lesions are typically located 12 mm from the limbus, as opposed to the
juxtalimbal position of CIN.
The geometrically arranged red dots on the surface of the lesion are pathognomonic for a
papilloma and are secondary to central vasculature surrounded by thickened epithelium.

Hiperplasia pseudoepiteliomatosa o pseudocarcinomatosa.

se distingue del carcinoma escamoso por la falta de atipia nuclear y la marcada
inflamacin
estromal subyacente.
Una variante de esta lesin con morfologa redondeada, bordes abruptos y elevados es el
queratoacantoma.
The conjunctival epithelium may respond to irritation by becoming acanthotic,
parakeratotic, or hyperkeratotic.
The distinguishing features of PEH are that it (1) develops rapidly over weeks or months,
(2) lacks nuclear atypia, and (3) contains intraepithelial microabscesses.
Because this lesion is not premalignant, simple excision is usually curative.
The lesion develops rapidly over weeks or months, usually because of irritation in a setting
of preexisting stromal inflammation by lesions such as pinguecula or pterygium.
 The typical clinical appearance is a white elevated mass with a hyperkeratotic surface and
sometimes an area of central umbilication similar to that seen in keratoacanthomas.
Characteristically, this lesion can be difficult to distinguish clinically from CIN.The history
of a rapid onset points toward the diagnosis of PEH.

Precancerosos
Queratosis actnica.
Son lesiones leucoplquicas, bien circunscritas, elevadas, lmbicas, que crecen lentamente
en el epitelio del rea interpalpebral, generalmente sobre una pingucula o pterigion
preexistente y pueden simular un carcinoma.
Puede evolucionar a carcinoma escamoso de conjuntiva, aunque es raro.
Actinic keratosis, or solar keratosis, develops slowly within the interpalpebral epithelium
after prolonged exposure to ultraviolet light.
Actinic keratosis appears as a sharply circumscribed leukoplakic plaque with atypia in the
epithelium.
As a result, it is considered a precancerous lesion, but its opacity and elevation
distinguish it from a flatter and translucent intraepithelial neoplasia.

Neoplasias intraepiteliales: Displasias/carcinoma in situ.

Son lesiones gelatinosas, sesiles o papilomatosas, con tendencia a la extensin difusa
superficial, generalmente en la hendidura interpalpebral afectando al limbo con bordes
mal definidos y suelen extenderse sobre el epitelio corneal.
El termino CIN (conjunctival intraepithelial neoplasia), incluye los distintos grados de
displasia (leve, moderada y grave) y el carcinoma in situ implicando que estas entidades
son diferentes niveles del espectro del desarrollo de una neoplasia intraepitelial,
considerada como lesin precancerosa, ya que si las clulas atpicas rompen la membrana
basal e invaden el tejido subconjuntival se produce el carcinoma escamoso invasivo de
conjuntiva.
Su curso, comparado con lesiones similares en otras localizaciones de la economa, es
relativamente benigno, ya que suele permanecer confinado al epitelio, y raras veces se
convierte en invasivo.
El diagnstico precoz es importante porque la biopsia escisional con margen de reseccin
con o sin tratamientos adyuvantes suele ser un tratamiento definitivo.
Neoplasias Intraepiteliales Conjuntivales circunscritas: lesiones lmbicas, exofticas,
vascularizadas con limites netos, que invaden cornea.
there is minimal hyperkeratosis and parakeratosis, giving the lesion an opalescent,
gelatinous surface and an abrupt transition from normal conjunctiva corresponding to its
sharply demarcated clinical appearance.
Human papillomaviruses (HPV) 16 and 18 have been implicated in the pathogenesis of
some of these lesions.
Human immunodefi ciency virus (HIV) infection should be ruled out in persons younger
than 50 years presenting with these lesions, as is the case with other severe viral
dermatologic conditions.
A more extensive CIN involving the limbus and central cornea. Despite its appearance, the
tumor did not invade Bowmans
membrane and can be removed with excision, cryotherapy to the limbal area, and superfi
cial scraping of the cornea.
 Ultraviolet light-induced mutations to the p53 tumor suppressor gene may play a role.
In addition to the connection between UV-B and CIN, other identified risk factors include
heavy smoking, previous exposure to petroleum derivatives, xeroderma pigmentosum,
and HPV.
HPV has been identified in both benign (types 6, 8, and 11) and malignant (types 16 and
18) conjunctival epithelial growths.
In doubtful cases, a focal lesion with parakeratosis should be classified as actinic keratosis,
whereas a diffuse lesion without parakeratosis should be classified as dysplasia.
The management of these lesions consists of a wide local excision plus cryotherapy.
During the excision, it is important to incorporate a surrounding area of 2 mm of
apparently uninvolved conjunctival epithelium to secure adequate surgical margins using a
no touch technique during removal.
Rose Bengal may be used topically to delineate the extent of the abnormal epithelium.
Eighteen percent alcohol can be used to facilitate removal of the corneal epithelium.
In general, it is best to avoid disturbing Bowmans layer, which acts as a natural barrier to
intracorneal tumor extension. If the entire lesion is resected and both the cut edges and
the base of the resection are treated with adjunctive cryotherapy, greater than 90% long-
term tumor control is achieved.
For the topical treatment of CIN, mitomycin C is most effective followed closely by 5-
fluorouracil, and then interferon alpha 2b.

Malignos
Carcinoma escamoso.
Se originan a partir de las queratosis actnicas y neoplasias intraepiteliales y aparecen
cuando un carcinoma in situ rompe la membrana basal e invade el tejido subconjunti val
accediendo a los vasos linfticos y adquiriendo potencial metasttico.
Clnicamente aparece como una lesin exofitica, sesil o pedunculada en el rea de
exposicin interpalpebral, de aspecto variable, frecuentemente cerca del limbo, de
crecimiento lento.
En su evolucin natural, puede crecer ocupando toda la conjuntiva bulbar y extenderse
posteriormente a travs del septum orbitario, invadiendo la orbita o invadir la lamela
esclerocorneal
penetrando en el globo ocular.
Although these tumors are more common in the elderly, they are also seen with some
frequency in young adults.
As is the case with CIN, squamous cell carcinoma in a young individual should alert the
physician to the possibility of HIV infection.
In contrast to CIN, invasive squamous cell carcinoma can involve a greater proportion of
the limbal area and be slightly larger.
Often an engorged conjunctival blood vessel can be seen feeding the tumor.

Carcinoma Mucoepidermoide.
Son raros y suelen aparecer en ancianos. Son ms agresivos que los carcinomas
escamosos, y tienden a invadir el globo ocular y la rbita.
Suele aparecer en fondo de saco conjuntival, presentando un componente globular
amarillento debido al componente de clulas mucosecretoras.
 se debe realizar una evaluacin preoperatoria completa que incluya una aproximacin
clnica al diagnostico lo mas precisa posible, si la lesin es circunscrita o difusa, uni o
bilateral, si se sospecha si es precancerosa o maligna.
Se debe evaluar extensin del tumor determinando la existencia de invasin intraocular
y/o orbitaria, realizando la palpacin de los linfticos regionales y, cuando se considere
indicado estudio de extensin sistmica para deteccin de metstasis.
Si existe invasin intraocular esta indicada la enucleacin; si adems hay invasin orbitaria
anterior, exenteracin anterior, con conservacin de los parpados, siempre que la
conjuntiva palpebral no est afectada.
The biopsies may be excisional or incisional depending on the size and predicted depth of
invasion.
Gonioscopy is recommended to confi rm that the tumor has not invaded the angle or
anterior chamber.

CRYOTHERAPY
Cryotherapy is effective because of its immediate thermal effect and subsequent
obliteration of the microcirculation, resulting in ischemic infarction of normal and tumor
tissues.
 Cryotherapy may also act by means of an immunologic response to liberated tumor
antigens, which may play a late role in ongoing policing of residual or recurrent tumor cells
at a cellular level.

Acantosis: aumento del tamao de la franja epitelial por aumento en el nmero de las
clulas espinosas del epitelio.
Hiperqueratosis :aumento del grosor de la capa crnea
Hiperqueratosis:Hiperplasia del estrato crneo, asociada a menudo a una alteracin
cualitativa de la queratina.
Paraqueratosis: Modos de queratinizacin caracterizados por la conservacin de los
ncleos del estrato crneo. La paraqueratosis es normal en las mucosas.
Disqueratosis: Queratinizacin anormal, que se produce de forma prematura en clulas
individuales o grupos de clulas situadas bajo el estrato granuloso.
Acantosis: Hiperplasia de la epidermis

Biopsia excisional: Tambin se llama exresis. Una biopsia excisional es la extirpacin

completa de un rgano o un tumor,
Biopsia incisional: Es la biopsia en la que se corta o se extirpa quirrgicamente slo un
trozo de tejido, masa o tumor.

La mitomicina-C es un antibitico aislado de los cultivos de Streptomyces caespitosus. Es

una droga antimittica y su mecanismo de accin consiste bsicamente en la formacin de
enlaces irreversibles entre las dos cadenas del ADN, impidiendo as la duplicacin. Es un
agente alquilante y en algunas de sus acciones es tambin radiomimtico (13). En el ojo,
su accin est encaminada a inhibir el crecimiento y proliferacin de clulas con actividad
fibroblstica
Los interferones son protenas producidas por las clulas inmunes que confieren una
resistencia no especfica frente a las infecciones virales, la proliferacin celular y adems
ayudan a modular la respuesta inmune. El mecanismo por el que tienen actividad
antitumoral es desconocido (15). Sus propiedades lo hacen til para el tratamiento de
tumores parcialmente inducidos por estimulacin antignica