Conjunctival Masses—May Part 2 Differential Diagnosis include: 1. Haemangioma (usually looks like a blood blister)2. Melanoma (usually black but ca

Conjunctival Masses—May Part 2

Differential Diagnosis include:

1. Haemangioma (usually looks like a blood blister)
2. Melanoma (usually black but can be amelanotic)
3. Limbal melanocytoma (smooth black swelling arising at the limbus)
4. NGEK Nodular granulomatous episcleriokeratoconjunctivitis (pale pink to cream-coloured swellings)

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Limbal Melanocytoma

These tumours arise from limbal melanocytes and appear as smooth, usually round black swellings at the limbus. They extend into the cornea and back into the sclera for variable distances. Limbal melanocytomas are usually benign but can continue to grow and interfere with function of the eye.

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Limbal Melanocytoma

Treatment is surgical excision via keratectomy and sclerectomy. It is possible to completely resect the pigmented tissue in some cases. Adjunctive treatment of the base with cryotherapy, diode laser or Strontium 90 is necessary. If the growth is full thickness, the structure of the globe is maintained via autogenous grafting with third eyelid cartilage.

Nodular Granulomatous Episcleriokeratitis

NGEK appear as benign swellings of the sclera with associated conjunctival hyperaemia. The most common anatomic position is lateral and ventrolateral sclera adjacent to the limbus, but any area may be affected. Breeds more commonly affected include Rottweilers and Shelties.

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Nodular Granulomatous Episcleriokeratitis

Treatment is the use of topical cortisone drops and systemic cortisone therapy. Most cases respond well however refractory cases may respond to oral tetracycline (500mg TID) or doxycycline (5mg/kg BID to TID) and nicotinamide (250-500mg TID). Cases refractory to this treatment may respond to cryotherapy or Strontium 90 brachytherapy. Recurrence is likely and long term therapy is usually required; dose and frequency rates may reduced to minimal levels to prevent recurrence and increased in response to flare-ups.

In all cases, clients must be warned to monitor for recurrence as early treatment will result in more complete excision and favourable outcome.

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