Skip to main content

The Conjunctival Biopsy

  • Chapter
  • First Online:

Abstract

Conjunctival tissue is rarely excised with enucleations so most material submitted is as scrapings or biopsies. Infection such as herpes simplex, molluscum or chlamydia may be diagnosed in conjunctiva scrapings. Atopy may also result in papillary conjunctivitis and giant papillae may be seen in contact lens wearers. Granulomatous inflammation may occur with sarcoidosis, and fungal infection as well as foreign bodies. Cicatrising conjunctivitis may be due to mucous membrane pemphigoid and immunofluorescent studies will be required to confirm the diagnosis. Various benign lesions including inclusion cysts and choristomas such as epibulbar dermoids may be submitted to pathology. Conjunctival papillomas may be associated with human papillomas virus infection and can recur. In situ and invasive squamous cell carcinoma can involve the conjunctiva and sebaceous carcinoma can involve the conjunctiva by pagetoid spread. Melanocytic lesions include naevi, primary acquired melanosis and malignant melanoma. Lymphomas are usually of mucosal associated lymphoid tissue type and are low grade. Some tumours are specific to the caruncle such as oncocytomas.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Redfern RL, McDermott AM. Toll-like receptors in ocular surface disease. Exp Eye Res. 2010;90:679–87.

    PubMed  CAS  Google Scholar 

  2. Knop E, Knop N. The role of eye-associated lymphoid tissue in corneal immune protection. J Anat. 2005;206:271–85.

    PubMed  Google Scholar 

  3. Bron AJ. Reflections on the tears. Eye. 1997;11:583–602.

    PubMed  Google Scholar 

  4. McLellan KA. Mucosal defence of the outer eye. Surv Ophthalmol. 1997;42:233–46.

    Google Scholar 

  5. Gachon A-MF, Lacazette E. Tear lipocalin and the eyes front line of defence. Br J Ophthalmol. 1998;82:453–5.

    PubMed  CAS  Google Scholar 

  6. Paulsen FP, Berry MS. Mucins and TFF peptides of the tear film and lacrimal apparatus. Prog Histochem Cytochem. 2006;41:1–53.

    PubMed  CAS  Google Scholar 

  7. Rivas L, Toledano A, Alvarez MI, Sanz AI, Oroza MA, Murube J. Ultrastructural study of the conjunctiva in patients with keratoconjunctivitis sicca not associated with systemic disease. Eur J Ophthalmol. 1998;8:131–6.

    PubMed  CAS  Google Scholar 

  8. Badouin C. The pathology of dry eye. Surv Ophthalmol. 2001;45 Suppl 2:S211–20.

    Google Scholar 

  9. Adams GG, Dilly PN. Differential staining of ocular goblet cells. Eye (Lond). 1989;3(Pt 6):840–4.

    Google Scholar 

  10. Sheppard JD, Kowalski RP, Meyer MP, Amortegui AJ, Slifkin M. Immunodiagnosis of adult chlamydial conjunctivitis. Ophthalmology. 1988;95:434–43.

    PubMed  CAS  Google Scholar 

  11. Friedlander MH, Okumoto M, Kelley J. Diagnosis of allergic conjunctivitis. Arch Ophthalmol. 1984;102:1198–9.

    Google Scholar 

  12. McGill JI, Holgate ST, Church MK, Anderson DF, Bacon A. Allergic eye disease mechanisms. Br J Ophthalmol. 1998;82:1203–14.

    PubMed  CAS  Google Scholar 

  13. Singh R, Joseph A, Umapathy T, Tint NL, Dua HS. Impression cytology of the ocular surface. Br J Ophthalmol. 2005;89:1655–9.

    PubMed  CAS  Google Scholar 

  14. Lopin E, Deveney T, Asbell PA. Impression cytology: recent advances and applications in dry eye disease. Ocul Surf. 2009;7:93–110.

    PubMed  Google Scholar 

  15. McKelvie P. Ocular surface impression cytology. Adv Anat Pathol. 2003;10:328–37.

    PubMed  Google Scholar 

  16. Chang SW, Hou PK, Chen MS. Conjunctival concretions. Polarised microscopic, histopathologic and ultrastructural studies. Arch Ophthalmol. 1990;108:405–7.

    PubMed  CAS  Google Scholar 

  17. Mora P, Carta A. Ocular manifestations of Lyme borreliosis in Europe. Int J Med Sci. 2009;6:124–5.

    PubMed  Google Scholar 

  18. Huppertz HI, Munchmeier D, Lieb W. Ocular manifestations in children and adolescents with Lyme arthritis. Br J Ophthalmol. 1999;83:1149–52.

    PubMed  CAS  Google Scholar 

  19. Marques AR. Lyme disease: a review. Curr Allergy Asthma Rep. 2010;10:13–20.

    PubMed  Google Scholar 

  20. Lee WR, Chawla JC, Reid R. Bacillary angiomatosis of the conjunctiva. Am J Ophthalmol. 1994;118:152–7.

    PubMed  CAS  Google Scholar 

  21. Tsai PS, DeAngelis DD, Spencer WH, Seiff SR. Bacillary angiomatosis of the anterior orbit, eyelid and conjunctiva. Am J Ophthalmol. 2002;134:433–4.

    PubMed  Google Scholar 

  22. Edmonson BC, Morris WR, Osborn FD. Bacillary angiomatosis with cytomegaloviral and mycobacterial infections of the palpebral conjunctiva in a patient with AIDS. Ophthal Plast Reconstr Surg. 2004;20:168–70.

    PubMed  Google Scholar 

  23. Golnik KC, Marotto ME, Fanous MM, Heitter D, King LP, Halpern JI, et al. Ophthalmic manifestations of Rochalimaea species. Am J Ophthalmol. 1994;118:145–51.

    PubMed  CAS  Google Scholar 

  24. Aragona P, Romeo GF, Puzzolo D, Micali A, Ferreri G. Impression cytology of the conjunctival epithelium in patients with vernal keratoconjunctivitis. Eye. 1996;10:82–5.

    PubMed  Google Scholar 

  25. Tuft SJ, Kemeny DM, Dart JK, Buckley RJ. Clinical features of atopic keratoconjunctivitis. Ophthalmology. 1991;98:150–8.

    PubMed  CAS  Google Scholar 

  26. Leonardi A, Motterle L, Bortolotti M. Allergy and the eye. Clin Exp Immunol. 2008;153 Suppl 1:17–21.

    PubMed  CAS  Google Scholar 

  27. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. 1977;83:697–708.

    PubMed  CAS  Google Scholar 

  28. Reccia R, Prete A, Scala A, Masciello M, Di Giovanni A, Sebastiani A. Direct immunofluorescence and scraping conjunctival cytology in the study of 912 patients affected by microfollicular conjunctivitis. Ophthalmologica. 1994;208:295–7.

    PubMed  CAS  Google Scholar 

  29. Reacher MH, Pe’er J, Rapoza PA, Whittum-Hudson JA, Taylor HR. T cells and trachoma: their role in cicatricial disease. Ophthalmology. 1991;98:334–41.

    PubMed  CAS  Google Scholar 

  30. Abu el-Asrar AM, Geboes K, Tabbara KF, al Karashi SA, Misotten L, Desmet V. Immunopathogenesis of conjunctival scarring in trachoma. Eye. 1998;12:453–60.

    PubMed  Google Scholar 

  31. Guzey M, Ozardali I, Basar E, Aslan G, Satici A, Karadede S. A survey of trachoma: the histopathology and the mechanism of progressive cicatrization of eyelid tissue. Ophthalmologica. 2000;214:277–84.

    PubMed  CAS  Google Scholar 

  32. Spaide RF, Ward DL. Conjunctival biopsy in the diagnosis of sarcoidosis. Br J Ophthalmol. 1990;74:469–71.

    PubMed  CAS  Google Scholar 

  33. Hegab SM, al-Mutawa SA, Sherriff SM. Sarcoidosis presenting as multilobular limbal corneal nodules. J Pediatr Ophthalmol Strabismus. 1998;35:323–6.

    PubMed  CAS  Google Scholar 

  34. Maguire LJ, Campbell RJ, Edson RS. Coccidioidomycosis with necrotizing granulomatous conjunctivitis. Cornea. 1994;13:539–42.

    PubMed  CAS  Google Scholar 

  35. Slack JW, Hyndiuk RA, Harris GJ, Simons KB. Blastomycosis of the eyelid and conjunctiva. Ophthal Plast Reconstr Surg. 1992;8:143–9.

    PubMed  CAS  Google Scholar 

  36. Reidy JJ, Sudesh S, Klafter AB, Olivia C. Infection of the conjunctiva by Rhinosporidium Seeberi. Surv Ophthalmol. 1997;41:409–13.

    PubMed  CAS  Google Scholar 

  37. Ghosh AK, De Sarkar A, Bhaduri G, Datta A, Das A, Bandyopadhyay A. Ocular rhinosporidiosis. J Indian Med Assoc. 2004;102(732):764.

    Google Scholar 

  38. Chan CM, Theng JT, Li L, Tan DT. Microsporidial keratoconjunctivitis in healthy individuals: a case series. Ophthalmology. 2003;110(7):1420–5.

    PubMed  Google Scholar 

  39. Schwartz DA, Visvesara GS, Diesenhouse MC, Weber R, Font RL, Wilson LA, et al. Pathologic features and immunofluorescent antibody demonstration of ocular microsporidiosis (Encephalitozoon hellem) in seven patients with acquired immunodeficiency syndrome. Am J Ophthalmol. 1993;115:285–92.

    PubMed  CAS  Google Scholar 

  40. Jafari AK, Akhyani M, Valikhani M, Ghodsi ZS, Barikban D, Toosi S. Bilateral cutaneous leishmaniasis of upper eyelids: a case report. Dermatol Online. 2006;12:12.

    Google Scholar 

  41. Pitts JF, Barker NH, Gibbons DC, Jay JL. Manchineel keratoconjunctivitis. Br J Ophthalmol. 1993;77:284–8.

    PubMed  CAS  Google Scholar 

  42. Chapman FM, Dickinson AJ, Figueiredo FC. Self induced cicatricial conjunctivitis. Eye. 1999;13:675–7.

    Google Scholar 

  43. Ashton N, Cook C. Allergic granulomatous nodules of the eyelid and conjunctiva. Am J Ophthalmol. 1979;87:1–28.

    PubMed  CAS  Google Scholar 

  44. McCartney ACE. Limbal allergic granulomatosis. Eye. 1989;3:172–9.

    PubMed  Google Scholar 

  45. Godfrey DG, Carr JD, Grossniklaus HE. Epibulbar allergic granulomatous nodules in a human immunodeficiency virus positive patient. Am J Ophthalmol. 1998;126:844–6.

    PubMed  CAS  Google Scholar 

  46. Font RL, Hunts JH. Botryomycosis of limbal conjunctiva with Splendore-Hoeppli phenomenon. Arch Ophthalmol. 1996;114:1006–8.

    PubMed  CAS  Google Scholar 

  47. Ooi KG, Drummond SR, Thompson KJ, Roberts F, Kemp EG. Churg-Strauss syndrome presenting with conjunctival nodules in association with Candida albicans and ankylosing spondylitis. Clin Experiment Ophthalmol. 2004;32(4):441–3.

    PubMed  Google Scholar 

  48. Teske SA, Hirst LW, Gibson BH, O’Connor PA, Watts WH, Carey TM. Caterpillar induced keratitis. Cornea. 1991;10:317–21.

    PubMed  CAS  Google Scholar 

  49. Hered RW, Spaulding AG, Sanitato JJ, Wander AH. Ophthalmia nodosa caused by tarantula hairs. Ophthalmology. 1988;95:166.

    PubMed  CAS  Google Scholar 

  50. Yanoff M, Perry HD. Juvenile xanthogranuloma of the corneoscleral limbus. Arch Ophthalmol. 1995;113:915–7.

    PubMed  CAS  Google Scholar 

  51. Burnstine MA, Headington JT, Reifler DM, Oestreicher JH, Elner VM. Periocular granuloma annulare, nodular type. Occurrence in late middle age. Arch Ophthalmol. 1994;112:1590–3.

    PubMed  CAS  Google Scholar 

  52. Albert DL, Brownstein S, Jackson WB, Fichman S. Idiopathic conjunctival granulomas. Can J Ophthalmol. 1992;27:184–8.

    PubMed  CAS  Google Scholar 

  53. Lucas DR, Dunham AC, Lee WR, Weir WC, Wilkinson FCF. Ocular injuries from liquid golf ball centres. Br J Ophthalmol. 1976;60:740–7.

    PubMed  CAS  Google Scholar 

  54. Resnick SC, Schainker BA, Ortiz JM. Conjunctival synthetic and non-synthetic fiber granulomas. Cornea. 1991;10:59–62.

    PubMed  CAS  Google Scholar 

  55. Ferry AP. Synthetic fiber granuloma. “Teddy bear” granuloma of the conjunctiva. Arch Ophthalmol. 1994;112:1339–41.

    PubMed  CAS  Google Scholar 

  56. Moorman CM, McDonald B. Primary (localised non-familial) conjunctival amyloidosis: three cases reports. Eye. 1997;11:603–6.

    PubMed  Google Scholar 

  57. Lee HM, Naor J, DeAngelis D, Rootman DS. Primary localized conjunctival amyloidosis presenting with recurrence of subconjunctival hemorrhage. Am J Ophthalmol. 2000;129:245–7.

    PubMed  CAS  Google Scholar 

  58. Leibovitch I, Selva D, Goldberg RA, Sullivan TJ, Saeed P, Davis G, et al. Periocular and orbital amyloidosis: clinical characteristics, management, and outcome. Ophthalmology. 2006;113(9):1657–64.

    PubMed  Google Scholar 

  59. Schuster V, Seregard S. Ligneous conjunctivitis. Surv Ophthalmol. 2003;48:369–88.

    PubMed  Google Scholar 

  60. Watts P, Suresh P, Mezer E, Ells A, Albisetti M, Bajzar L, Marzinotto V, Andrew M, Massicotle P, Rootman D. Effective treatment of ligneous conjunctivitis with topical plasminogen. Am J Ophthalmol. 2002;133:451–5.

    PubMed  CAS  Google Scholar 

  61. Foster CS, Fong LP, Azar D, Kenyon KR. Episodic conjunctival inflammation after Stevens-Johnson syndrome. Ophthalmology. 1988;95(4):453–62.

    PubMed  CAS  Google Scholar 

  62. Leonard JN, Hobday CM, Haffenden GP, Griffiths CE, Powles AV, Wright P, et al. Immunofluorescent studies in ocular cicatricial pemphigoid. Br J Dermatol. 1988;118:209–17.

    PubMed  CAS  Google Scholar 

  63. Frith PA, Venning VA, Wojnarowska F. Conjunctival involvement in cicatricial and bullous pemphigoid: a clinical and immunopathological study. Br J Ophthalmol. 1989;73:52–6.

    PubMed  CAS  Google Scholar 

  64. Sacks EH, Jakobiec FA, Wieczorek R, Donnenfeld E, Perry H, Knowles Jr DM. Immunophenotypic analysis of the inflammatory infiltrate in ocular cicatricial pemphigoid. Further evidence for a T-cell mediated disease. Ophthalmology. 1989;96:236–43.

    PubMed  CAS  Google Scholar 

  65. Mondino BJ. Cicatricial pemphigoid and erythema multiforme. Ophthalmology. 1990;97:939–52.

    PubMed  CAS  Google Scholar 

  66. Rice BA, Foster S. Immunopathology of cicatricial pemphigoid affecting the conjunctiva. Ophthalmology. 1990;97:1476–83.

    PubMed  CAS  Google Scholar 

  67. Hoang-Xuan T, Rodriguez A, Zaltas MM, Rice BA, Foster CS. Ocular rosacea. A histologic and immunopathologic study. Ophthalmology. 1990;97:1468–75.

    PubMed  CAS  Google Scholar 

  68. Power WJ, Neves RA, Rodriguez A, Dutt JE, Foster S. Increasing the diagnostic yield of conjunctival biopsy in patients with suspected ocular cicatricial pemphigoid. Ophthalmology. 1995;102:1158–63.

    PubMed  CAS  Google Scholar 

  69. Kocak-Altinas AG, Kocak-Midilloglu I, Gul U, Bilezikci B, Isiksacan O, Duman S. Impression cytology and ocular characteristics in ocular rosacea. Eur J Ophthalmol. 2003;13:351–9.

    Google Scholar 

  70. Heilinghaus A, Dutt JE, Foster CS. Histology and immunopathology of systemic lupus erythematosus affecting the conjunctiva. Eye. 1996;10:425–32.

    Google Scholar 

  71. Neumann R, Dutt CJ, Foster CS. Immunohistopathologic features and therapy of conjunctival lichen planus. Am J Ophthalmol. 1993;115:494–500.

    PubMed  CAS  Google Scholar 

  72. Tseng SCG, Prabhasawat P, Lee S-H. Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol. 1997;124:765–74.

    PubMed  CAS  Google Scholar 

  73. Goldstein MH, Soparkar CNS, Kersten RC, Orcutt JC, Patrinely JR, Holds J. Conjunctival cysts of the orbit. Ophthalmology. 1998;10–5:2056–60.

    Google Scholar 

  74. Jaros PA, de Luise VP. Pingueculae and pterygia. Surv Ophthalmol. 1988;33:41–9.

    PubMed  CAS  Google Scholar 

  75. Di Girolamo N, McCluskey P, Lloyd A, Coroneo MT, Wakefield D. Expression of MMPs and TIMPs in human pterygia and cultured pterygium epithelial cells. Invest Ophthalmol Vis Sci. 2000;41:671–9.

    PubMed  Google Scholar 

  76. Yeung SN, Kim P, Lichtinger A, Amiran MD, Cote E, Teitel S, Slomovic AR. Incidence of ocular surface squamous neoplasia in pterygium specimens: an 8-year survey. Br J Ophthalmol. 2011;95(4):592.

    PubMed  Google Scholar 

  77. Ferry AP, Kaltreider SA, Wyatt DB. Actinic granuloma of the conjunctiva. Arch Ophthalmol. 1984;102:1200–2.

    PubMed  CAS  Google Scholar 

  78. Gallagher MJ, Roberts F, Osborne S, Kirkness CM. Actinic granuloma of the conjunctiva. Br J Ophthalmol. 2003;87:1044–5.

    PubMed  CAS  Google Scholar 

  79. Mansour AM, Barber JC, Reinecke RD, Wang FM. Ocular choristomas. Surv Ophthalmol. 1989;33:339–58.

    PubMed  CAS  Google Scholar 

  80. Le Marc’hadour F, Romanet JP, Fdili A, Peoc’h M, Pinel N. Schwannoma of the bulbar conjunctiva. Arch Ophthalmol. 1996;114:1258–60.

    PubMed  Google Scholar 

  81. Scott KR, Tse DT, Kronish JW. Hemorrhagic lymphangiectasis of the conjunctiva. Arch Ophthalmol. 1991;109:286–7.

    PubMed  CAS  Google Scholar 

  82. Pokorny KS, Hyman BM, Jakobiec FA. Epibulbar choristomas containing lacrimal tissue. Clinical distinction from dermoids and histologic evidence of an origin from the palpebral lobe. Ophthalmology. 1987;94:1249–57.

    PubMed  CAS  Google Scholar 

  83. Lucarelli MJ, Ceisler EJ, Talamo JH, Jakobiec FA. Complex choristoma. Arch Ophthalmol. 1996;114:498–9.

    PubMed  CAS  Google Scholar 

  84. Casey RJ, Garner A. Epibulbar choristoma and microphthalmia: a report of two cases. Br J Ophthalmol. 1981;75:247–50.

    Google Scholar 

  85. Pe’er J, Ilsar M. Epibulbar complex choristoma associated with nevus sebaceous. Arch Ophthalmol. 1995;113:1301–4.

    PubMed  Google Scholar 

  86. Ganesh A, Rangaswamy M. Pedunculated dermolipoma with overlying upper lid coloboma and absent lateral canthus: cause and effect? Eye. 1999;13:687–9.

    PubMed  Google Scholar 

  87. Duncan JL, Golabi M, Fredrick DR, Hoyt CS, Hwang DG, Kramer SG, Howes Jr EL, Cunningham Jr ET. Complex limbal choristomas in linear nevus sebaceous syndrome. Ophthalmology. 1998;105:1459–65.

    PubMed  CAS  Google Scholar 

  88. Kalantzis G, Papaconstantinou D, Georgalas I, Tsitlidou A, Georgopoulos G. Different types of conjunctival papillomas presenting in the same eye. Orbit. 2010;29:266–8.

    PubMed  Google Scholar 

  89. Sjo NC, von Buchwald C, Cassonnet P, Norrild B, Prause JU, Vinding T, Heegard S. Human papillomavirus in normal conjunctival tissue and in conjunctival papillomas: types and frequencies in a large series. Br J Ophthalmol. 2007;91:1014–5.

    PubMed  Google Scholar 

  90. Whittaker KW, Trivedi D, Bridger J, Sandramouli S. Ocular surface squamous neoplasia: report of an unusual case and review of the literature. Orbit. 2002;21:209–15.

    PubMed  Google Scholar 

  91. Pe’er J. Ocular surface squamous neoplasia. Ophthalmol Clin North Am. 2005;18:1–13.

    PubMed  Google Scholar 

  92. Nagaiah G, Stotler C, Orem J, Mwanda WO, Remick SC. Ocular surface squamous neoplasia in patients with HIV infection in sub-Saharan Africa. Curr Opin Oncol. 2010;22:437–42.

    PubMed  Google Scholar 

  93. Spitzer MS, Batumba NH, Chirambo T, Bartz-Schmidt KU, Kayange P, Kalua K, Szurman P. Ocular surface neoplasia as the first apparent manifestation of HIV infection in Malawi. Clin Experiment Ophthalmol. 2008;36:422–5.

    PubMed  Google Scholar 

  94. Gupta A, Muecke J. Treatment of ocular surface squamous neoplasia with Mitomycin C. Br J Ophthalmol. 2010;94:555–8.

    PubMed  CAS  Google Scholar 

  95. Buus DR, Tse DT, Folberg R. Microscopically controlled excision of conjunctival squamous cell carcinoma. Am J Ophthalmol. 1994;117:97–102.

    PubMed  CAS  Google Scholar 

  96. Robinson JW, Brownstein S, Jordan DR, Hodge WG. Conjunctival mucoepidermoid carcinoma in a patient with ocular cicatricial pemphigoid and a review of the literature. Surv Ophthalmol. 2006;51:513–9.

    PubMed  Google Scholar 

  97. Huntington AC, Langloss JM, Hidayat AA. Spindle cell carcinoma of the conjunctiva: an immunohistochemical and ultrastructural study of six cases. Ophthalmology. 1990;97:711–7.

    PubMed  CAS  Google Scholar 

  98. Vasudev P, Boutross-Tadross O, Radhi J. Baraloid squamous cell carcinoma: two case reports. Cases J. 2009;2:9351.

    PubMed  Google Scholar 

  99. Margo CE, Grossniklaus HE. Intraepithelial sebaceous neoplasia without underlying invasive carcinoma. Surv Ophthalmol. 1995;39:293–301.

    PubMed  CAS  Google Scholar 

  100. Mooy CM. Intraepithelial sebaceous neoplasia invading the lacrimal gland. Br J Ophthalmol. 1997;81:612–3.

    PubMed  CAS  Google Scholar 

  101. Folberg R, McLean IW, Zimmerman LE. Primary acquired melanosis of the conjunctiva. Hum Pathol. 1985;16:129–35.

    PubMed  CAS  Google Scholar 

  102. Folberg R, McLean IW, Zimmerman LE. Malignant melanoma of the conjunctiva. Hum Pathol. 1985;16:136–43.

    PubMed  CAS  Google Scholar 

  103. Folberg R, Jakobiec FA, Bernardino VB, Iwamoto T. Benign melanocytic conjunctival lesions. Ophthalmology. 1989;96:436–51.

    PubMed  CAS  Google Scholar 

  104. Jakobiec FA, Folberg R, Iwamoto T. Clinicopathologic characteristics of premalignant and malignant lesions of the conjunctiva. Ophthalmology. 1989;96:147–66.

    PubMed  CAS  Google Scholar 

  105. Damato B, Coupland SE. Conjunctival melanoma and melanosis: a reappraisal of terminology, classification and staging. Clin Experiment Ophthalmol. 2008;36:786–95.

    PubMed  Google Scholar 

  106. Zembowicz A, Mandal RV, Choopong P. Melanocytic lesions of the conjunctiva. Arch Pathol Lab Med. 2010;134:1785–92.

    PubMed  Google Scholar 

  107. Sharara NA, Alexander RA, Luthert PJ, Hungerford JL, Cree AI. Differential immunoreactivity of melanocytic lesions of the conjunctiva. Histopathology. 2001;39:426–31.

    PubMed  CAS  Google Scholar 

  108. Chowers I, Livni N, Solomon A, Zajicek G, Frucht-Pery J, Folberg R, Pe’er J. MIB-1 and PC-10 immunostaining for the assessment of proliferative activity in primary acquired melanosis without and with atypia. Br J Ophthalmol. 1998;82:1316–9.

    PubMed  CAS  Google Scholar 

  109. Sugiura M, Colby KA, Mihm Jr MC, Zembowicz A. Lowe-risk and high-risk histologic features in conjunctival primary acquired melanosis with atypia: clinicopathologic analysis of 29 cases. Am J Surg Pathol. 2007;31:185–92.

    PubMed  Google Scholar 

  110. Damato B, Coupland SE. Management of conjunctival melanoma. Expert Rev Anticancer Ther. 2009;9:1227–39.

    PubMed  Google Scholar 

  111. Chalasani R, Giblin M, Conway RM. Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and cornea: review of the evidence and recommendations for treatment. Clin Experiment Ophthalmol. 2006;34:708–14.

    PubMed  Google Scholar 

  112. Shields JA, Shields CL, Mashayekhi A, Marr BP, Benavides R, Thangappan A, Phan L, Eagle Jr RC. Primary acquired melanosis of the conjunctiva: experience with 311 eyes. Trans Am Ophthalmol Soc. 2007;105:61–71.

    PubMed  Google Scholar 

  113. Demirci H, McCormick SA, Finger PT. Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: clinical experience with histopathologic observations. Arch Ophthalmol. 2000;118(7):885–91.

    PubMed  CAS  Google Scholar 

  114. Norregaard JC, Gerner N, Jensen OA, Prause JU. Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population. Graefes Arch Clin Exp Ophthalmol. 1996;234:569–72.

    PubMed  CAS  Google Scholar 

  115. Paridaens ADA, Minassian DC, McCartney ACE, Hungerford JL. Prognostic factors in primary malignant melanoma of the conjunctiva: a clinicopathologic study of 256 cases. Br J Ophthalmol. 1994;78:252–9.

    PubMed  CAS  Google Scholar 

  116. Kurli M, Finger PT. Melanocytic conjunctival tumors. Ophthalmol Clin North Am. 2005;18:15–24.

    PubMed  Google Scholar 

  117. Tuomaala S, Kivela T. Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy. Ophthalmology. 2004;111:816–21.

    PubMed  Google Scholar 

  118. Reddy S, Finger PT, Chynn EW, Iacob CE. Reactive lymphoid hyperplasia one month after LASIK surgery. Graefes Arch Clin Exp Ophthalmol. 2006;244:529–31.

    PubMed  Google Scholar 

  119. Finger PT, Perry HD, Kempin S, Iacob CE. High-frequency ultrasound of extranodal limbal Rosai-Dorfman disease: affecting the conjunctiva, sclera and cornea. Cornea. 2007;26:888–90.

    PubMed  Google Scholar 

  120. Kim HJ, Shields CL, Eagle Jr RC, Shields JA. Fibrous histiocytoma of the conjunctiva. Am J Ophthalmol. 2006;142:1036–43.

    PubMed  Google Scholar 

  121. Arora R, Monga S, Mehta DK, Raina UK, Gogi A, Gupta SD. Malignant fibrous histiocytoma of the conjunctiva. Clin Experiment Ophthalmol. 2006;34:275–8.

    PubMed  Google Scholar 

  122. Charles NC, Ostriker GE. Epibulbar conjunctival fibroma. Ophthal Plast Reconstr Surg. 2007;23:249–50.

    PubMed  Google Scholar 

  123. Pe’er J, Maly A, Deckel Y, Frenkel S. Solitary fibrous tumor of the conjunctiva. Arch Ophthalmol. 2007;125:423–6.

    PubMed  Google Scholar 

  124. Chen CL, Tai MC, Chen JT, Chen CH, Jin JS, Lu DW. A rare case of conjunctival myxoma and a review of the literature. Ophthalmologica. 2008;222:136–9.

    PubMed  Google Scholar 

  125. Dugel PU, Gill PS, Frangieh GT, Rao NA. Ocular adenexal Kaposi’s sarcoma in acquired immunodeficiency syndrome. Am J Ophthalmol. 1990;110:500–3.

    PubMed  CAS  Google Scholar 

  126. Dugel PU, Gill PS, Frangieh GT, Rao NA. Treatment of ocular adnexal Kaposi’s sarcoma in acquired immunodeficiency syndrome. Ophthalmology. 1992;99:1127–32.

    PubMed  CAS  Google Scholar 

  127. Brun SC, Jakobiec FA. Kaposi’s sarcoma of the ocular adnexa. Int Ophthalmol Clin. 1997;37:25–39.

    PubMed  CAS  Google Scholar 

  128. Chang Y, Cesarman E, Pessin MS, Lee F, Culperpper JC, Knowles DM, Moore PS. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994;266:1865–9.

    PubMed  CAS  Google Scholar 

  129. Ron IG, Kremer I, Lowenstein A, Chaitchik S. Conjunctival involvement in classic (indolent) HIV negative Kaposi’s sarcoma. Br J Ophthalmol. 1994;78:488–9.

    PubMed  CAS  Google Scholar 

  130. Shields CL, Shields JA, White D, Augsburger JJ. Types and frequency of lesions of the caruncle. Am J Ophthalmol. 1986;102(6):771–8.

    PubMed  CAS  Google Scholar 

  131. Levy J, Ilsar M, Deckel Y, Maly A, Pe’er J. Lesions of the caruncle: a description of 42 cases and a review of the literature. Eye. 1999;23:1004–18.

    Google Scholar 

  132. Filho JP, Vianna RN, Coutinho AB, Arthurs B, Burnier Jr MN. Oncocytoma of the caruncle: a clinicopathologic case report. Int Ophthalmol. 2004;25:321–3.

    PubMed  Google Scholar 

  133. Ostergaard J, Prause JU, Heegaard S. Oncocytic lesions of the ophthalmic region: a clinicopathological study with emphasis on cytokeratin expression. Acta Ophthalmol. 2011;89(3):263–7. doi:10.1111/j.1755-3768.2009.01677.x.

    PubMed  Google Scholar 

  134. Morand B, Bettega G, Bland V, Pinel N, Lebeau J, Raphael B. Oncocytoma of the eyelid. An aggressive benign tumour. Ophthalmology. 1998;105:2220–4.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Roberts, F., Thum, C.K. (2014). The Conjunctival Biopsy. In: Lee's Ophthalmic Histopathology. Springer, London. https://doi.org/10.1007/978-1-4471-2476-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2476-4_11

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2475-7

  • Online ISBN: 978-1-4471-2476-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics