Presentation


A 14-year-old Caucasian boy presented for evaluation of a recurrent conjunctival lesion. The lesion had developed in the inferior fornix of his right eye eight months prior. He was first prescribed tobramycin/dexamethasone and prednisolone acetate drops for what was suspected to be a pyogenic granuloma. He had no improvement after one month and the medications were discontinued. By the end of the next month, his lesion resolved. Two months later the patient presented once again with recurrence of the same lesion. At this point, he was referred to a pediatric ophthalmologist for excisional biopsy, and histopathology disclosed a pyogenic granuloma. Two months later, the lesion recurred once again, prompting referral to Wills Eye Hospital Ocular Oncology Service.

 

Medical History

He had no reported past ocular history. He didn’t wear glasses or contact lenses. He had no prior medical conditions. Family history was notable for lung cancer in his paternal and maternal grandmothers and thyroid cancer in his mother. The patient was a middle school student and played on the school’s baseball team.

 

Examination

Ocular examination revealed visual acuity of 20/20 in both eyes. Pupils were round and equally reactive to light. Intraocular pressure was normal by finger tension. Confrontational visual fields and ocular motility were full. Anterior segment examination was notable for a firm, palpable, amelanotic 10 x 10-mm nodule within the tarsus of the right lower eyelid and a pedunculated, soft, vascular pyogenic granuloma in the adjacent inferior fornix (Figure 1). Further anterior segment examination was unremarkable. 

Dilated examination revealed normal vitreous, retina, choroid and optic discs bilaterally.



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