Non-Syndromic Supernumerary Caruncles Causing Ocular Irritation After Cataract Surgery: A Critical Review of Caruncular Dysgeneses
Accepted 30 September 2009.
Purpose
To describe a patient with 2 ipsilateral supernumerary caruncles and to determine if they are predictive of associated abnormalities.
Design
Retrospective and interventional clinicopathologic study with a critical review of the literature over the past 100 years.
Methods
Assessment of clinical features and histopathologic findings in paraffin-embedded tissue sections stained with hematoxylin and eosin, Masson trichrome, periodic acid–Schiff (PAS) reaction with and without diastase, and Ziehl-Neelsen method.
Results
Two placoid lesions causing ocular irritation after routine phacoemulsification were discovered in the inferomedial palpebral conjunctiva. They were totally separate from a normal caruncle. Their surface was studded with yellowish micronodules with projecting white vellus hairs. There were no associated local ophthalmic or systemic abnormalities. Microscopically, they were covered by a goblet cell–rich, nonkeratinizing squamous epithelium with subadjacent pilosebaceous units, the hairs of which were highlighted by the Masson trichrome and Ziehl-Neelsen stains, and small lobules of lacrimal gland tissue. The ocular irritation has not returned after surgery.
Conclusions
A literature review confirms that supernumerary (extra) caruncles coexisting with a normal caruncle are always unilateral and unassociated with any other ocular anomalies, as in the current case. They may, however, cause ocular irritation. They must be distinguished from ectopic (topographically displaced) or dysplastic caruncles that are generally bilateral and often associated with ocular adnexal abnormalities or Goldenhar syndrome. Ectopic or dysplastic caruncles, but not supernumerary ones, are characteristically accompanied by plical abnormalities or its absence. Well-documented supernumerary and ectopic caruncles have always been located in the inferior palpebral conjunctiva.
aDepartment of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
bDavid G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
cThe Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
Inquiries to Frederick A. Jakobiec, MD, DSc, Massachusetts Eye and Ear Infirmary, Suite 321, 3rd Fl, 243 Charles St, Boston, MA 02114
ABSTRACT