A man with an ocular mass.

PATIENT PRESENTATION

An otherwise healthy 30‐year‐old male presented to the emergency department (ED) with a painless, growing lesion noted over the right eye. The patient explained he first noted the mass 1 year ago but it had been expanding in size over the past month. Examination revealed a mass lesion at the caruncle with intact visual acuity and normal ocular range of motion (Figure 1).

FIGURE 1

Gross examination of the right eye.

DIAGNOSIS

Conjunctival papilloma. No diagnostic tests were performed in the ED, and the patient was referred for outpatient evaluation by ophthalmology. The patient underwent a biopsy that revealed findings consistent with a papilloma. The decision was made to forego excision because of the potential risk of seeding additional lesions and the possibility of recurrence. The patient opted not to proceed with any other therapeutic options.

The differential diagnosis for ocular masses at the medial canthus includes papillomas, oncocytomas (which are often benign), granulomas, cysts, and malignancies. Conjunctival papilloma development is strongly associated with human papilloma virus types 6 and 11. These squamous cell papillomas usually are seen in younger patients and patients with previous cutaneous warts at extraocular locations. Small papillomas may regress spontaneously. Other management strategies include excision, cryotherapy, and pharmacotherapy with cytotoxic and immunomodulating drugs. Although an emergency physician will not be expected to manage conjunctival papillomas in the ED, knowledge of the differential diagnosis of a mass at the caruncle of the eye can help emergency physicians appropriately counsel patients who come to the ED with this uncommon problem.