Nodule at the limbus

Limbus is the transitional zone at the junction of the sclera and the cornea.

1 mm wide

Duration Slow or fast growing Vascular /non vascular H/o trauma or surgery Change in colour Associated symptoms Progression of growth

Congenital Inflammatory Allergic Vascular Traumatic Degenerative Nutritional Neoplastic miscellaneous

1. Dermoid2. Dermolipoma3. Raised Naevus

DERMOID Yellowish white mass Consists of epithelium , sebaceous

gland, hair Treatment: Excision

DERMOLIPOMA

soft , yellow and movable Subconjunctival mass Adipose tissue & dermis

around Associated with Goldenhar’s

syndrome

Flat or raised ,grey gelatinous ,brown,black

Tendency to grow during puberty and pregnancy

May undergo malignant change

Treatment: excision if it grows

Episcleritis Scleritis

EPISCLERITIS Inflammation of deep conjunctival

tissue Pinkish elevated tender nodule or

diffuse Occurs in

gout ,Rheumatism ,endogenous allergy to bacteria

Treatment: topical steroids or NSAIDs Systemic Indomethacin Recurrence – systemic

therapy

SCLERITIS– Nodular or diffuse form Nodule is fixed to sclera Pain and uveitis Causes– collagen

disorders,Endogenous infections.

Treatment: steroids

Phlycten Vernal catarrah– limbal

form Ophthalmia nodosa

Pinkish white nodules surrounded by congestion

causes photophobia , lacrimation , blepharospasm

Endogenous reaction to tuberculous protein

Treatment: topical steroids and treat the cause

Multiple nodules in the upper limbus , white superficial spots

White ropy discharge Hypersensitivity to exogenous

allergen – pollen and dust Recurrence occurs in summer Common in children Treatment : steroids , mast

cell stabilizers, NSAIDs

Granulomatous inflammation to caterpillar hair

Treatment: steroid or excision

Benign red lesion which blanches on pressure

Bleeds on trivial trauma May be associated with

hemangioma of lid and orbit

Granuloma Implantation cyst Iris prolapse covered by conjunctiva

GRANULOMA After surgical wound (squint or

pterygium surgery) Site of foreign body Treatment – surgical excision

Pingecula Cystic pterygium

Triangular yellow patch on nasal limbus

Occurs in elderly Hyaline infiltration with

elastotic degeneration of subconjunctival tissue

Treatment – excision for cosmetic purposes

Triangular sheet of fibrovascular tissue invading cornea

Occurs after recurrence Treatment – excision and

auto conjunctival transplantation

Silvery white, foamy or cheesy patch

Keratinised epithelium – temporal limbus

Seen in vitamin A deficiency

Papilloma Intraepithelial

epithelioma Squamous cell carcinoma Primary melanoma

Benign polypoid tumour Sessile/peduncle Can become malignant Treatment: surgical excision

SQUAMOUS CELL CARCINOMA Flat granular growth Invades underlying

structures Requires early excision

Nodular form, may be pigmented or non-pigmented

Treatment - excision

Intercalary or ciliary staphyloma

Filtering bleb – following trabeculectomy

Parasitic cyst – cysticercosis

Retention cyst

Bulge in limbal area Lined by root of iris due to

ectasia of weak scar tissue Following healed perforation

injuries or corneal ulcer

Thin walled cyst with clear fluid

Excision indicated if there is irritation or foreign body sensation or for cosmetic purposes