Pseudoepitheliomatous Hyperplasia as a Limbal Mass Mimicking Nodular Episcleritis

Dear Editor, Pseudoepitheliomatous hyperplasia (PEH) is a benign proliferation of the conjunctival or corneal epithelium that occurs in response to inflammatory conditions [1]. There are a few reports of occurrence of PEH presenting as a limbal mass, especially in inflammatory conditions such as vernal keratoconjunctivitis (VKC) [2-4]. Here, we describe an uncommon case of PEH with vascular tortuosity of the conjunctiva in a patient misdiagnosed with nodular episcleritis. The diagnosis of PEH was confirmed by histopathologic findings. A 28-year-old man was referred to Farabi Eye Hospital emergency department with a complaint of local pain and redness in his right eye for 1 month. The past medical and ocular surgical history were unremarkable, with no history of atopy or contact lens wear. He had been diagnosed with nodular episcleritis in another ophthalmology clinic and was treated with topical betamethasone and diclophenac drops every 6 hours for 8 weeks. He had no improvement using these medications. Upon initial examination, his visual acuity was 10 / 10 in both eyes. Slit lamp examination was normal except for the right eye, in which there was a grayish nodular, placoid-free mobile elevated mass with white pearly hypertrophied conjunctiva, sized approximately 2 mm × 3 mm and located at the nasal side of the limbus (Fig. 1A). There was a ciliary injection at the nasal conjunctivae and around the lesion, with tortuosity and dilation of episcleral vessels resembling sentinel vessels. Other ophthalmic examinations were unremarkable in both eyes. Based on the fact that the patient had no response to topical corticosteroids and nonsteroidal anti-inflammatory drugs, and also considering the features of the lesion (nodular mass with leukoplakia), concerns were raised regarding malignancy. An excisional biopsy was performed. The lesion was excised with a 1 mm margin with amniotic membrane transplantation and the specimen was sent in formalin for histopathologic examination. The pathology report (Fig. 1B) revealed a stratified squamous Korean J Ophthalmol 2016;30(2):148-149 http://dx.doi.org/10.3341/kjo.2016.30.2.148 Correspondence