Isolated Corneal Squamous Cell Intraepithelial Neoplasia in a Patient with Unilateral Dry Eye Symptoms

To report a case of isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms.Case report: A 48 year old man presented with history of thermal corneal injury in his left eye two years ago, with decreased visual acuity and dry eye symptoms a short time thereafter. He was treated for dry eye with no improvement in symptoms. Upon presentation, slit lamp examination revealed near total hypertrophy of the corneal epithelium with distinct and scalloped border, without limbal or conjunctival involvement. The patient underwent excisional biopsy (debridement) of the corneal epithelium. Histopathology revealed severe corneal dysplasia (carcinoma in situ). After excision, the patient was treated with fluorouracil drops 50 mg/dl QID and there was no sign of recurrence up to 1.5 months after surgery. At final follow-up, visual acuity was 9/10 and dry eye symptoms had completely disappeared.

In patients with unilateral chronic dry eye refractory to treatment and signs of corneal epithelial involvement, isolated corneal neoplasia should be considered even without limbal or conjunctival involvement.