Corneal intraepithelial neoplasia
A. Discuss superficial keratectomy to confirm the diagnosis by histopathologic examination
Calcium chelation with EDTA therapy (choice B) is not recommended because the appearance and location of the lesion are atypical for band keratopathy. Performing a penetrating keratoplasty (choice C) would not be indicated because the lesion is superficial and does not affect the deeper cornea stromal layers. Finally, observation (choice D) would not be preferred because the patient is experiencing visual issues due to the lesion, and other conditions, such as a malignant neoplasm, should be excluded.
Corneal intraepithelial neoplasia (CIN), also known as corneal epithelial dysplasia, is usually grouped with conjunctival intraepithelial neoplasia under the broader classification of ocular surface squamous neoplasia (OSSN). Ocular surface squamous neoplasia is one of the most common ocular tumors in the US and is generally found in males of advanced age.1 Risk factors include prolonged exposure to UV light, infection with human papillomavirus or human immunodeficiency virus, smoking, and immunosuppression.2 Patients customarily present with nonspecific progressive symptoms of painless vision loss, which may be associated with ocular foreign body sensation or redness.3 Corneal intraepithelial neoplasia onset is typically in the limbal area, with a gradual extension toward the central visual axis. Lesions may or may not be accompanied by neovascularization.