Ocular Microbiology and Immunology Group
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2024 OMIG Abstract

Infectious Etiologies of Conjunctival Tumors

Michael Antonietti, Osmel P. Alvarez, David Monroy, Soraiya Thura, Sohaib Fasih-Ahmad, Paula Sepulveda, Sara Culbertson, Sander R. Dubovy, Anat Galor, Carol L. Karp

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida

Purpose: This study aims to elucidate the role of infectious agents in the etiology of conjunctival tumors including lymphoma, ocular surface squamous neoplasia (OSSN), papilloma, and Kaposi sarcoma, and to discuss their impact on diagnosis and treatment strategies.

Methods: A literature review of articles published between 1952 and 2024 was conducted on PubMed, using keywords “infection and conjunctival lymphoma”, “infection and OSSN”, “infection and conjunctival papilloma”, “infection and conjunctival Kaposi sarcoma”. The search yielded 552 peer reviewed articles. Inclusion was based on the relevant contribution to epidemiology, etiology, diagnostics, management and long-term consequences of these conjunctival tumors. The oncogenic mechanisms, infectious etiologies, diagnostic modalities, and treatment options of these tumors were then analyzed.

Results: The literature highlighted the association between Chlamydia sp. and ocular adnexal lymphomas (OALs), detecting C. psittaci DNA variably but as high as 80% of OAL specimens. Doxycycline has proven effective in both Chlamydia-positive and -negative OALs, inducing regression in some instances. The prevalence of high-risk human papilloma virus (HPV) strains in ocular surface squamous neoplasia (OSSN) varies significantly by region, with detection rates ranging from 0% to 100%. The nonvalent HPV vaccine, has shown early promise as an adjunct treatment for OSSN, potentially reducing lesion sizes. Conjunctival papilloma is mainly associated with low-risk HPV strains, particularly HPV 6 and 11. Kaposi sarcoma (KS), a low-grade vascular tumor primarily affecting HIV patients, has been linked to human herpesvirus 8 (HHV8) since 1994. With the advent of highly active antiretroviral therapies (HAART), the incidence of ocular KS has declined, yet it remains an important consideration for eye care professionals.

Conclusions: Recognizing the potential infectious origins of conjunctival tumors is crucial in tailoring treatment strategies and improving patient outcomes. Ongoing research into novel diagnostic and treatment modalities, including those targeting the infectious agents, holds promise for effective management of these tumors.


Disclosure:

N (MA, OPA, DM, ST, SFA, PS, SC, SRD, AG); S, all institutional; P (CLK, PCT/US2022/029842, 63/627,578; and 63/435,503 with the University of Miami); C (CLK, medical advisory board for Glaukos)