Superior Conjunctiva Research Articles

Mullerectomy for Upper Eyelid Retraction in Graves' Orbitopathy

Conclusions: Muller’s muscle is a sympathetically innervated muscle that inserts upon the upper border of the superior tarsal plate and provides 2 mm of lift. Eyelid retraction is the most common eyelid abnormality in GO. Upper eyelid surgery involves lengthening or weakening of Muller’s muscle and/or the levator aponeurosis. The mullerectomy procedure has received little attention in the otolaryngology literature. Mullerectomy is a safe and effective procedure that has been shown to improve upper eyelid position, lagophthalmos, exposure keratopathy, and patient comfort. The failure rate is low and is most often due to undercorrection. Otolaryngologists should consider mullerectomy as an option for addressing upper eyelid retraction in GO. Mullerectomy was performed via a posterior conjunctival approach. Operative steps include: •Evert the upper eyelid to expose the superior palpebral conjunctiva (Figure 2). •Incise the conjunctiva at the superior tarsal border. •Dissect the conjunctiva from Muller’s muscle by raising a conjunctival flap (Figure 3). •Incise Muller’s muscle above the superior tarsal border. •Dissect Muller’s muscle from the levator aponeurosis (Figure 4). •Excise Muller’s muscle. •Close the conjunctival incision with absorbing sutures.

Ocular surface squamous neoplasia masquerading as superior limbic keratoconjunctivitis

To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic keratoconjunctivitis (SLK). A 62-year-old woman was referred with foreign body sensation, irritation, photophobia and decreased vision in the left eye. She was initially treated for 10 months with intermittent topical corticosteroids for a presumed diagnosis of SLK. She underwent excisional biopsy of the superior conjunctiva and was found, on histopathologic evaluation, to have OSSN with moderate to marked dysplasia. This is the first reported case of OSSN masquerading with signs and symptoms of SLK. Any ocular surface lesion refractory to standard medical treatment should raise suspicion for a malignant process and warrant further cytologic or histopathologic evaluation.

Impression Cytologic Analysis After Corneal Collagen Cross-Linking Using Riboflavin and Ultraviolet- A Light in the Treatment of Keratoconus

To report impression cytologic (IC) results after corneal cross-linking (CXL) using riboflavin and ultraviolet-A light in the treatment of keratoconus and compare the data with those from a group of subjects with the same disease. Forty eyes were distributed into 2 groups: patients in group 1 underwent CXL, whereas patients in group 2 received riboflavin 0.1% eyedrops for 1 month of topical use. IC specimens were obtained from all eyes before treatment and 1 and 3 months after treatment. Patients in group 1 showed a decrease in goblet cell density on the superior conjunctiva after CXL (P = 0.008) but no difference on the temporal conjunctiva or in the cornea. Patients in group 2 demonstrated improvement in cell-to-cell contact of epithelial cells and reduced keratinization on the temporal conjunctiva after treatment (P = 0.003 and P = 0.034, respectively) but no changes on the superior conjunctiva or in the cornea. Fisher exact test comparison of IC total scores after treatment revealed no difference between groups. Despite changes in goblet cell density after corneal CXL in the superior conjunctiva and an improvement in the morphology of epithelial cells after the use of riboflavin eyedrops, comparison of total IC scores showed no difference between groups.

Recurrent subconjunctival hemorrhages leading to the discovery of ocular adnexal lymphoma

Background Subconjunctival hemorrhages commonly occur idiopathically or from causes including ocular surgery, trauma, anticoagulation medications, or a Valsalva maneuver. When a hemorrhage persists or recurs, a more extensive list of differential diagnoses must be considered. This report details a case in which persistent subconjunctival hemorrhages led to the discovery of ocular adnexal lymphoma. Case Report A 68-year-old white man presented with a 7- to 8-month history of a recurrent red left eye. There was no associated pain, discharge, or change in vision over that time. The right eye was never involved. An ocular examination of the left eye found a mild nasal subconjunctival hemorrhage and a salmon-pink–colored lesion involving the superior conjunctiva. Clinical findings, photos, magnetic resonance images, and histopathology results are presented and reviewed. The signs, symptoms, incidence, pathophysiology, treatment, and prognosis of ocular adnexal lymphoma are also discussed. Conclusion Lymphomas can occur in a variety of sites in the body. It is well documented that primary tumors can originate in the ocular adnexa. Although not typical, the first sign in this case was a recurrent subconjunctival hemorrhage. The importance of a thorough ocular examination is paramount for a patient's ocular health and possibly the patient's life.

Reply to Aniridia—To Be or Not To Be?

Dr. Wong seeks clarification of the location of the biopsy in patients with bilateral disease. As stated in our Methods section, we took biopsies from the superior forniceal conjunctiva in these patients (1). Aniridia is a bilateral disease. Our patient with aniridia had superior bulbar conjunctival biopsies taken at the fornix. This site is believed to contain conjunctival stem cells (2–4). Dr. Wong is correct in stating that the patient with aniridia has a human iris. Aniridia is a rare congenital condition that presents with a range of ocular signs and is due to failure of the eye to develop fully. Signs of aniridia include iris hypoplasia, nystagmus, glaucoma, cataract, keratopathy from limbal stem-cell failure, and foveal and optic nerve hypoplasia. There is heterogeneity in the phenotypic expression of aniridia (5–7), such that in our patient, aniridia presented with a normal or near normal iris. Nick Di Girolamo Department of Pathology School of Medical Sciences University of New South Wales Sydney, Australia Stephanie L. Watson Department of Ophthalmology Prince of Wales Hospital Sydney, Australia

A Simple Step to Preserve Superior Conjunctiva During Encircling Scleral Buckling

A Simple Step to Preserve Superior Conjunctiva During Encircling Scleral Buckling

Conjunctival Epithelial Flap in Continuous Contact Lens Wear

Composed of sheets of cells detached from the underlying conjunctiva, conjunctival epithelial flap (CEF) is a recently reported phenomenon associated with contact lens wear with potential consequences for ocular health. Although CEF is generally asymptomatic, it is not known to what extent it might increase the longer-term risk of discomfort, inflammatory response, or infection. In this study, we use survival analysis methods to obtain unbiased estimates of the probability of developing CEF, the mean survival time free of CEF, and the effects of age, gender, ethnicity, and contact lens type. Two hundred four subjects were recruited for a continuous wear (CW) study of silicone hydrogel (SiH) and gas permeable (GP) contact lenses. Subjects were examined by optometrists throughout contact lens adaptation and CW periods. Statistical methods included the Kaplan-Meier nonparametric estimator of the survival function and the Cox proportional hazards model for estimating the relative effects of covariates. Of the 204 subjects, 72 (35%) developed CEF. In 64% of cases, CEFs were observed bilaterally. The majority of cases (90.3%) presented with CEF in the superior conjunctiva. Mean survival time free of CEF was longer for GP lenses (94.3 days) than for SiH lenses (76.5 days), and the probability of developing CEF was significantly greater for SiH lenses (p = 0.002). Although there was some evidence that women and non-Asians remain free of CEF longer, the effects of age, gender, and ethnicity were not statistically significant. There was a significantly increased risk of CEF in subjects wearing SiH lenses, compared with GP lenses. Subjects wearing SiH lenses remained free of CEF for a shorter time on average. Further study is needed to determine whether the increased incidence of CEF in CW with SiH lenses poses an increased risk of adverse ocular response or infection.

Normal human bulbar conjunctiva on confocal microscopy in vivo

To analyze the morphology of human bulbar conjunctiva by in vivo laser scanning confocal microscopy. This research was a cross-sectional study. From February to July 2008, 50 eyes of 50 healthy subjects were enrolled in this study. They had no history of ocular trauma, infection or contact lens wear and had no found after routine slit-lamp examinations. In vivo laser scanning confocal microscopic examinations were performed on the superior, inferior, nasal and temporal bulbar conjunctiva and the images were recorded. The morphology of bulbar conjunctiva was analyzed and the density of epithelial cells, dendritic cells and goblet cells were calculated. One-way analysis of variance (ANOVA) was used to compare the means of epithelial cell densities in different layers and goblet cell densities in different positions. Subsequently the datum between two groups were analyzed by least significant difference (LSD). Superficial epithelial cells of bulbar conjunctiva were characterized as large loose-arranged cells with a hyporeflective nucleus. The mean density is (1643 +/- 206) cells/mm(2). Intermediate epithelial cells were captured with features of oval small tight-arranged cells with a punctiform hyperreflective nucleus. The mean density is (4693 +/- 228) cells/mm(2). Basal epithelial cells appeared to be polygonal and regular-arranged within hyperreflective cell borders. The mean density is (4420 +/- 230) cells/mm(2). There was a significant difference among three kinds of conjunctival epithelium (F = 1160.312, P = 0.000). The presumed goblet cell was defined as a large hyperreflective oval-shaped cell with relatively homogeneous brightness, crowded in groups or mainly dispersed. The mean density is (432 +/- 72) cells/mm(2). The dendritic cell appeared to be hyperreflective corpuscular particles with dendritic processes scattered among conjunctival epithelial cells. The mean density is (22 +/- 25) cells/mm(2). The basement membrane, a prominent hyperreflective band, separated epithelial cells from subepithelial structure. Bulbar conjunctival substantia propria, beneath the basement membrane, was mainly composed of highly vascularized, loose connective tissues which were irregularly arranged fibers or a network of fibers, punctiform hyperreflective immune cells and sharp flows of blood vessels. In vivo laser scanning confocal microscopy is a useful tool in the analysis of the bulbar conjunctival morphology, which provided a fast and noninvasive method for the diagnosis of ocular surface diseases.

Segurança e efetividade no tratamento do pterígio usando infiltração de 5-fluoruracila no intraoperatório

To investigate the safety and efficacy of intraoperative infiltration of 5-fluorouracil (5-FU) as an adjuvant drug in pterygium treatment. Of 125 consecutive patients, 125 eyes with primary and recurrent pterygium underwent pterygium excision with intraoperative 5-FU (25 mg/mL) infiltration. The superior and inferior conjunctiva was approximated to cover the scleral bed and 0.2 mL 5-FU was injected at the end of the surgical procedure. The gender, occupation, pterygium characteristics and the follow-up at 7, 21, 60 e 180 days after surgery were evaluated and the data were statistically analyzed. With follow-up of 180 days the patients had no serious complications observed during or after surgery. The relapse rate was 35.8% and occurred in primary (35.7%) and recurrent (36.4%) lesions with no statistical difference. This study suggests that intraoperative infiltration of 5-FU is safe. However the high recurrence rate indicated that other studies would be necessary to show the concentration/dose to better prevent it.

Pars plana vitrectomy from a temporal approach for a patient with a deep orbit.

To present an alternate technique for safely performing pars plana vitrectomy (PPV) for patients with extremely deep-set eyes or prominent brow ridges. A single patient with a very deep orbit and severe glaucoma that limited the surgeon's ability to operate on the superior conjunctiva underwent 25-gauge PPV with the surgeon seated temporally. Twenty-five-gauge PPV with epiretinal membrane peeling and intraocular lens suturing was performed safely. PPV can be performed from a temporal approach if the access to the superior conjunctiva is limited.

A Conjunctival Mass in the Deep Superior Fornix After a Long Retained Hard Contact Lens in a Patient With Keloids

To report a case of an upper eyelid mass induced by a rigid contact lens retained for more than 3 years in the eye of a patient with a general history of keloids and to provide a review of the literature on retained contact lenses. Case report. A 45-year-old woman with an ophthalmologic history of dry eyes and follicular chronic conjunctivitis presented at our department complaining of irritation, mucous discharge, and contact lens intolerance in her left eye. The ophthalmic examination revealed a visual acuity of 20/20 in both eyes and bilateral blepharitis. A pseudoptosis and an impressive mass growing from the superior tarsal conjunctiva with a lot of mucous discharge were present in the left eye. After a delay of 3.5 years with persisting complaints, a double lid eversion revealed the presence of a hard contact lens retained in the deep fornix of the left eye. After removing the lens and a short period of treatment with local corticosteroids, the mass and the symptoms disappeared. In patients who wear or wore contact lenses and present with one-sided chronic irritation and tissue proliferation, the possibility of a retained contact lens should be considered. The previous history of dry eyes and chronic conjunctivitis led us to miss the diagnosis at the first visits, despite persisting complaints. No other cases about the effects of a retained contact lens in a patient with keloids have been previously reported.

Pediatric allergic conjunctivitis and allergic rhinitis

Objective To assess the relationship between allergic conjunctivitis(AC) and allergic rhinitis(AR) in pediatric ophthalmology and E.N.T outpatient clinic. Methods Eight hundred and ninety two patients were enrolled in survey during Mar. 2005∼Jan. 2007, 407 allergic conjunctivitis cases were placed in the ophthalmology clinic group and 485 allergic rhinitis cases were from the E.N.T clinic. The comorbid disorders, histories, symptoms, signs of patients were recorded. Type 1 allergy was tested in 479 cases by a specific IgE antibody blood test. Eosinophils were detected in superficial conjunctival scrapings of the superior tarsal conjunctiva and mucosa surface scrapings of middle nasal meatus in 88 cases with both diseases. Results 302(74%), 374(92%), 116(29%) in 407 cases with allergic conjunctivitis had concomitant eczema, rhinitis and asthma, respectively; 334(69%), 430(89%), 145(30%) in 485 cases with allergic rhinitis had concomitant eczema, allergic conjunctivitis and asthma, respectively. The prevalence of allergic conjunctivitis concomitant allergic rhinitis and allergic rhinitis concomitant allergic conjunctivitis had no significant difference(x 2=2.6, P > 0.05). The prevalence of allergic conjunctivitis and allergic rhinitis concomitant eczema and asthma also had no significant difference (x 2=3.08; x 2=0.21, P > 0.05). The degree of severity of two kinds of disease symptoms is not parallel, in the patients with seasonal allergic conjuctivitis(SAC) and perennial allergic conjunctivitis(PAC), the clinical signs of AR were always severer(x 2=258.2, P < 0.05) than those of AC. However, the results coincided with the cases with vernal keratoconjuctivitis(VKC)(x 2=66.5, P < 0.05); Eosinophils were revealed in 50(57%) conjunctival scrapings and nasal mucosa scrapings(x 2=1.5, P > 0.05), 47(53%) cases had positive results in both scrapings. The main aeroallergens were house dust mites, house dust and fungi, and the main food-allergens were fish, crab and shrimp. Conclusion The two disorders were shown to share more similarities than differences, as suggested that allergic conjunctivitis should be considered in future guidelines on preventing the development of rhinitis and asthma in children.

Developmental Changes in Conjunctiva-Associated Lymphoid Tissue of the Rabbit

Organized conjunctiva-associated lymphoid tissue (O-CALT) is constantly exposed to environmental antigens and plays a central role in the common mucosal immune system. This study was undertaken to investigate whether O-CALT in rabbit lymphoid tissue, as in other lymphoid tissue in other mammals, changes with age. Fluorescence stereomicroscopy was used to measure the number and size of conjunctival follicles stained with propidium iodide in rabbits ranging in age from 2 days to 57 months. To assess the function of M cells, an antigen-sampling cell type found in the follicle-associated epithelium, transcytosis of fluorescent latex beads was evaluated with confocal microscopy. O-CALT was not present in rabbits at birth, but appeared less than 24 hours after eyes opened at approximately day 11. The number of follicles increased with age until adolescence (2-4 months), when the number stabilized through early adulthood (17-20 months). In aged rabbits (47-57 months), there was a dramatic decline in the number of follicles. This disappearance was most pronounced in the superior conjunctiva. Average follicle diameter increased with age, except in the superior conjunctiva of aged rabbits, where the few remaining follicles were generally smaller. The uptake of latex beads showed that M-cell function was similar in all age groups. Age-related changes in rabbit O-CALT are similar to those that have been reported for the human conjunctiva. Preferential uptake of latex beads by follicle-associated epithelium indicates that the presence and function of M cells are not affected by aging. The lower level of O-CALT in young and elderly animals, however, would be expected to decrease their ocular mucosal immune responses.

Filtering bleb-induced giant papillary conjunctivitis

Pathogenesis of giant papillary conjunctivitis is still elusive and many hypotheses are being proposed to explain the irritative symptoms associated with it. The research data available to date shows that mechanical, immunological and allergic components are involved in this to various extents. We report a rare cause of giant papillary conjunctivitis which was induced by a large filtering bleb following trabeculectomy surgery for glaucoma. A 30-year-old female, operated for glaucoma filtering surgery in her right eye 15 years back, presented with ocular irritation. Clinical evaluation revealed two giant papillae on the superior tarsal conjunctiva which coincided with the large filtering bleb with its peripheral extension. The fellow eye was normal and no association with any allergic disorders was noted. The patient responded symptomatically to the topical application of anti-inflammatory and anti-allergic medications. The giant papillae decreased considerably in size but the diffuse papillary response persisted. Though multiple etiological factors have been proposed for the giant papillary conjunctivitis, only a single case report is available where a filtering bleb is the causative factor. The mechanical irritation caused by the large-sized bleb seems to be the provoking agent in our case taking into consideration the position of the papillae that coincides with the peripheral extension of the bleb.

Effect of Mitomycin‐C on the conjunctival goblet cell density after lasik

Abstract Purpose: To study the effect of mitomycin‐C (MMC) on the conjunctival epithelium after LASIK ablation. Methods: This preliminary study comprised 18 patients scheduled for LASIK to correct myopia. The patients were divided into 2 groups of 9 patients each. In Group 1, the flap was performed with a mechanical microkeratome (M2, Moria), wereas in Group 2 a femtosecond laser (IntraLase) was used. For each patient topical MMC 0.02% was applied on the right eye with a Merocell sponge for 60 seconds, over the bulbar superior conjunctiva covering an area of 64 mm2 before the surgery. Conjunctival goblet cell density was studied by impression cytology pre‐operatively, and at one, two and three months after surgery. Results: Analysis by impression cytology of the ocular surface showed that preoperative goblet cell density was not significantly different between the eyes with and without MMC (G1: P=0.81 and G2: P=0.50).1 month after LASIK surgery there was a significant decrease in the goblet cell density in both groups (G1: P&lt;0.008 and G2: P&lt;0.022). However, there were no statistically significant differences in the goblet cell density between the right and left eye, at any time after the surgery, in any of the two groups (G1: P&gt;0.62 and G2: P&gt;0.08). Conclusions: Topical MMC 0.02% for 60 seconds over the bulbar conjunctiva before the LASIK surgery does not seem to affect the conjunctival goblet cell density in this preliminary study.

Immunohistochemical findings in prosthesis‐associated giant papillary conjunctivitis

To identify functional subsets of inflammatory cells and expression of cytokines in the conjunctiva of patients with ocular prosthesis-associated giant papillary conjunctivitis (P-GPC). Specific immunohistochemical staining using monoclonal antibodies was performed on biopsy specimens obtained from superior tarsal conjunctiva of 18 patients with P-GPC. The prosthetic eyes were taken as the study group, whereas their fellow eyes were used as matched controls. In normal conjunctiva, mast cells (MCs) were located only in the substantia propria (SP), whereas in P-GPC eyes MCs were also notable in the epithelium in five specimens. Tryptase-chymase-positive MCs (MC(TC)) were predominant both in P-GPC (79%) and in fellow (72%) eyes. MC(TC), CD4(+) lymphocyte, CD8(+) lymphocyte and eosinophil numbers were higher in P-GPC specimens compared with the fellow eyes (P = 0.005, 0.074, 0.012 and 0.025, respectively). Eosinophils were detected in 58.8% of P-GPC specimens and 16.7% of control specimens (P = 0.053). The number of inflammatory cells expressing eotaxin and interleukin (IL)-4 was higher in P-GPC group (P = 0.050 and 0.048, respectively). Nine out of 17 giant papillary conjunctivitis specimens (52.9%) showed eotaxin and IL-4 immunoreactivity, which was considerably higher than the fellow eyes (16.7%) (P = 0.064). These findings suggest that P-GPC is an allergic disease of the eye associated with increased numbers of MC, eosinophils and lymphocytes in the conjunctiva and a remarkable expression of IL-4 and eotaxin both by the conjunctival epithelium and by the inflammatory cells in the SP.

Effect of Suction Ring Application During LASIK on Goblet Cell Density

To study the effect of LASIK surgery on conjunctival goblet cells as one of the proposed mechanisms for dry eye occurring after LASIK. This prospective study included 22 eyes (11 patients) that underwent LASIK for the correction of myopia. Three pairs of samples were taken from the bulbar conjunctiva of each eye. The first pair was taken preoperatively before application of the suction ring. The second and third pairs were taken from the same sites at 1 week and 1 month consecutively. The first site was at 12 o'clock and the second at the inferotemporal quadrant between 7 and 8 o'clock. Time of suction was recorded. Preoperatively, mean goblet cell density was 424 +/- 105 cells/mm2 (range: 284 to 630 cells/mm2). All postoperative samples showed a statistically significant decrease in goblet cell count: 216 +/- 81 cells/mm2 (range: 40 to 325 cells/mm2) at 1 week and 218 +/- 99 cells/mm2 (range: 50 to 396 cells/mm2) at 1 month. Other parameters of conjunctival impression cytology were normal. The difference between the samples in the inferior conjunctiva preoperatively and 1 week postoperatively was greater than that of the superior conjunctiva. Recovery rate in both sites was similar and the damage did not correlate with the duration of suction. The application of the microkeratome suction ring induced changes in the perilimbic conjunctiva. These changes contribute to the pathology of dry eye. Goblet cell count remains affected at 1 month postoperatively.

Severe pseudo–preseptal cellulitis following sub–Tenon’s carboplatin injection for intraocular retinoblastoma

Sub-Tenon or subconjunctival administration of carboplatin is used to consolidate tumor regression by achieving high intraocular concentrations, without incurring systemic toxicity, in selected patients with intraocular retinoblastoma. Mild transient periocular edema is a common side effect of this treatment. We describe four patients with severe local soft-tissue toxic reaction mimicking preseptal cellulitis following subtenon carboplatin injections. The development of this complication after injecting through the inferior conjunctiva and unexpectedly severe signs are the unusual features of these patients. We did not encounter this complication after injections through the superior conjunctiva in 22 other patients using the same technique and identical drug dosage.

Exposure to a dry environment induces strain-specific responses in mice

Most current animal models of dry eye have a single causative mechanism and do not take into consideration the influence of environmental conditions on tear secretion and associated ocular surface signs. Since immunity and inflammation have been implicated in dry eye pathogenesis, and different mouse strains are known to have differentially biased immune responses, we conducted the present study to test the hypothesis that strains with specifically polarized T cell responses (T helper-1 [Th1] vs. T helper-2 [Th2]) develop differential signs of dry eye when exposed to a controlled low humidity setting. Eight to 12-week-old BALB/c (Th2 biased) and C57BL/6 (Th1 biased) mice were placed in a controlled environment chamber (CEC) where relative humidity (RH), temperature (T), and air flow (AF) were continuously regulated and monitored. Mice were exposed to specific environmental controlled conditions (RH = 15.5 ± 3.8%, AF = 15 l/min, T = 21–23 °C) for 3 to 7 days. Aqueous tear production by means of the cotton thread test, corneal fluorescein staining (NEI grading scheme, score 0–15) and goblet cell density in the superior and inferior conjunctivae were measured by a masked observer. No statistically significant differences between the groups were found at baseline. Statistically significant decreases in tear secretion were seen after exposure to the CEC environment. Mean cotton thread wetting was 1.9 ± 0.2 (baseline), 1.4 ± 0.3 (day 3), and 0.9 ± 0.2 mm (day 7) for BALB/c mice, and 1.7 ± 0.3 (baseline), 0.9 ± 0.3 (day 3), and 0.4 ± 0.2 mm (day 7) for C57BL/6 mice. These mice showed reduced tear secretion as compared to BALB/C at each time point tested ( P < .005, t-test). Both BALB/c and C57BL/6 mice showed a significant increase in corneal fluorescein staining at both day 3 and day 7 as compared to baseline. With exposure to the CEC goblet cell density significantly decreased in the superior and inferior conjunctivae in BALB/c mice, while it remained unchanged in C57BL/6 mice. This study indicates that exposure of non-pharmacologically modified mice to a low humidity environment in the CEC can lead to significant alterations in tear secretion, goblet cell density, and acquisition of dry eye-related ocular surface signs which are strain-specific.

Eyelid Sebaceous Carcinoma Associated With Muir-Torre Syndrome in Two Cases

We report the rare but serious association between sebaceous carcinoma of eyelid and Muir-Torre syndrome in two cases, a 79-year-old woman and 54-year-old man. The presenting sign was a yellow-pink nodule with telangiectatic vessels on the left lower eyelid in one patient and a yellowish-red, pedunculated lesion with intrinsic vascularization on the right superior tarsal conjunctiva in the other. A history of multiple primary colon cancers was present in both patients, associated transitional cell carcinoma of bladder and renal cancer in one patient and prostate cancer in the other. Both patients underwent excisional biopsy and cryotherapy of the eyelid tumors. Histopathology revealed sebaceous carcinoma of eyelid and conjunctiva. Immunohistochemical staining for MSH2 DNA mismatch repair gene performed in one patient showed lack of expression. Muir-Torre syndrome was diagnosed on the basis of sebaceous carcinoma, associated with multiple visceral malignancies in both patients. We conclude that patients with sebaceous carcinoma should have evaluation for visceral malignancies, mainly colon cancer.