Conjunctival Papilloma Features and Outcomes Based on Age at Initial Examination

Importance: Conjunctival papilloma is a benign epithelial tumor occurring in both children and adults with varying clinical features and outcomes. In this article, we describe our experience regarding the difference in the clinical features and outcomes of conjunctival papilloma based on age at initial examination. Objective: To evaluate the clinical features, treatment, and outcomes in patients with conjunctival papilloma based on age at initial examination. Design: Retrospective study. Setting: Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania. Participants: Ten children and adolescents (aged <= 20 years) and 63 adults (aged >20 years) with conjunctival papilloma. Interventions: Excisional biopsy, cryotherapy, oral cimetidine, topical or injection interferon alfa-2b, and photodynamic therapy. Main Outcome Measure: Tumor response. Results: A comparison of conjunctival papillomas between age groups revealed significant differences in the mean number of tumors per eye (children and adolescents vs adults, 2 vs 1; P=.05), tumor basal dimension (8 vs 6 mm; P=.05), and associated feeder vessels (20% vs 47%; P=.05). Primary treatment included sole treatment with oral cimetidine (15% vs 5%), topical interferon alfa-2b (0% vs 1%), cryotherapy (0% vs 3%), photodynamic therapy (0% vs 1%), excisional biopsy and cryotherapy (38% vs 65%), excisional biopsy and cryotherapy with adjuvant oral cimetidine (8% vs 9%), and excisional biopsy and cryotherapy with adjuvant topical or injection interferon alfa-2b (38% vs 15%). Significant differences in age groups in treatment outcome during the follow-up period (mean, 24 vs 38 months) included complete regression with single treatment (38% vs 95%; P=.01) and tumor recurrence (15% vs 1%; P=.05). Conclusions and Relevance: Conjunctival papillomas are larger and more likely to be multiple in children and adolescents than in adults. Excisional biopsy and cryotherapy with or without adjuvant oral cimetidine and/or topical interferon alfa-2b provide satisfactory tumor control. Papilloma recurrence is more common in children and adolescents than in adults.