Abstract
The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia (OSSN). Over the past two decades, the pharmacological management of OSSN has grown, with topical 5-fluorouracil, mitomycin, and interferon alpha 2b all being successfully used to treat this disease. Other agents, such as anti-vascular endothelial growth factor (VEGF), retinoic acid, cidofovir and Aloe vera, have less frequently been used in the treatment of OSSN. This review will discuss these pharmacologic agents, summarizing available data and presenting the approach to the treatment of these tumors.
Highlights
BackgroundOcular surface squamous neoplasia (OSSN) encompasses a spectrum of corneal as well as conjunctival lesions ranging in severity from epithelial dysplasia to conjunctival intraepithelial neoplasia in situ to invasive squamous cell carcinoma (SCC)
Clinical presentation Ocular surface squamous neoplasia (OSSN) typically presents unilaterally, but it can be bilateral, especially in individuals with xeroderma pigmentosum (XP), human immunodeficiency virus (HIV), and atopic states/allergy [23]
Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of corneal as well as conjunctival lesions ranging in severity from epithelial dysplasia to conjunctival intraepithelial neoplasia in situ to invasive squamous cell carcinoma (SCC)
Summary
Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of corneal as well as conjunctival lesions ranging in severity from epithelial dysplasia to conjunctival intraepithelial neoplasia in situ to invasive squamous cell carcinoma (SCC). Epidemiology OSSN incidence has been reported to range from 0.13 to 1.9 per 100,000 individuals, and varies with geography, with higher incidences in areas of greater sun exposure (such as Africa) as compared with areas with less sun (such as Denmark) [6, 7] Men in their 6th decade of life are commonly affected, but these lesions can occur in younger individuals, especially when associated with xeroderma pigmentosum (XP) or human immunodeficiency virus (HIV) [8–11]. Individuals with XP are at an increased risk of UV-induced cell damage due to an inability to repair mutations in the DNA [10, 15, 16] and are more susceptible to both ocular surface and cutaneous malignancies [17] Another possible risk factor is the human papilloma virus (HPV) which has been found more frequently in OSSN specimens compared to healthy conjunctiva [18], the frequency of detection varies with region (low in countries such as India, Germany and Taiwan but high in cities such as Miami, Florida). (2019) 6:24 suppressive and immune-deviated states, such as in HIV and atopy/allergy, have been associated with OSSN, likely due to impairment in tumor recognition by immune cells [9, 15, 20–22]
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