Medscape is available in 5 Language Editions – Choose your Edition here.


Conjunctival Papilloma Workup

  • Author: Hon-Vu Q Duong, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Mar 06, 2015

Laboratory Studies

No laboratory studies are indicated.


Imaging Studies

No imaging studies are indicated.




Biopsy (incisional or excisional) is a reasonable and safe method that aids in obtaining a definitive diagnosis. Indications for a biopsy are as follows:

  • To rule in or to rule out the possibility of malignancy
  • For lesions not obviously benign (symptomatic and/or show growth)
  • For neoplasms suggestive of malignancy (HIV-positive patients or chronic unilateral conjunctivitis unresponsive to therapy)
  • Therapeutic decision
  • To determine the surgical margin in ill-defined lesions
  • To exclude the possibility of recurrent neoplastic changes
  • To harvest tissue for special studies (ie, flow cytometry)

Frozen section

The most common indication for a frozen section is to determine whether surgical margins are free of tumor (ie, to assess the adequacy of tissue excision).

A frozen section should not be used for an "on-the-spot" diagnosis, since frozen tissue rendered tissue morphology is less optimal for microscopic examination.

Invasive disease can be excluded, but intraepithelial lesions may not.

Conjunctival tissue tends to curl after excision; therefore, it is best to examine after fixation and inking the borders. After obtaining the biopsy, place the tissue flat on a piece of firm paper/cardboard before placing in fixation medium.

Surface tissue sampling

Exfoliative cytology (tissue scraping)

This technique is used commonly to aid in the diagnosis of cervical disease. However, this technique and its role in aiding the ophthalmologist in diagnosing ocular surface lesions are less well defined.

Major limitations include the possibility of false-negative results and its inability to determine the depth of invasion.

Most benign and inflammatory lesions cannot be identified precisely by cytologic methods.

It is useful as a guide for where to obtain a biopsy specimen or resect ill-defined conjunctival lesions.

Impression cytology

Another technique for collecting surface cells, impression cytology uses a cellulose acetate filter paper. When the filter paper is placed in direct contact with the surface cells, the cells adhere to the paper.

Impression cytology is less traumatic than exfoliative cytology.

Intracellular structures are better preserved than with exfoliative cytology.

Limitations are similar to exfoliative cytology; both are not appropriate for identifying intraepithelial tumors.


Histologic Findings

Squamous cell papillomas (eg, infectious papilloma, viral conjunctival papilloma) are composed of multiple branching fronds emanating from a narrow pedunculated base. Individual fronds are surrounded by connective tissue, each having a central vascularized core. Acute and chronic inflammatory cells are found within these fronds. The epithelium is acanthotic, nonkeratinized stratified squamous epithelium without atypia. Numerous goblet cells are seen along with acute inflammatory cells. Koilocytosis is exhibited. The basement membrane is intact.

Limbal papillomas are sessile lesions arising from a broad base with a gelatinous appearance. Corkscrew vascular loops and feeder vessels are seen. The epithelium is acanthotic, displaying varying degrees of pleomorphism and dysplasia. The epithelium surface may be keratinized with foci of parakeratosis within the papillary folds. The basement membrane is intact.

Inverted papillomas exhibit exophytic and endophytic growth patterns. Invagination into the underlying stroma instead of the exophytic growth pattern is exhibited by squamous cell or limbal papillomas, whereas some lesions exhibit a mixture of exophytic and endophytic growth patterns. Unlike inverted papilloma arising in the lateral nasal wall or paranasal sinuses, lesions arising from the conjunctiva tend to be less aggressive in malignant transformation. The lesions are composed of lobules of epithelial cells extending down into the stroma. The lesion may be elevated or umbilicated. Epithelial cells do not demonstrate atypia, and dysplastic changes are uncommon for conjunctival inverted papillomas. The cytoplasm is vacuolated in some cells. They may resemble squamous papilloma or pyogenic granuloma. Numerous goblet cells are intermixed with the epithelium. Cysticlike lesions may be seen secondary to the confluence of goblet cells. The lesion may contain melanin granules and/or melanocytes.

Contributor Information and Disclosures

Hon-Vu Q Duong, MD Clinical Instructor of Ophthalmology and Ophthalmic Pathology, Westfield Eye Center; Senior Lecturer of Neurosciences:Anatomy and Physiology, Nevada State College

Hon-Vu Q Duong, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.


Robert A Copeland, Jr, MD Chair, Professor, Department of Ophthalmology, Howard University College of Medicine

Robert A Copeland, Jr, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Stephen D Plager, MD 

Stephen D Plager, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, California Medical Association

Disclosure: Nothing to disclose.

  1. Peck N, Lucarelli MJ, Yao M, et al. Human papillomavirus 6a lesions of the lower eyelid and genitalia. Ophthal Plast Reconstr Surg. 2006 Jul-Aug. 22(4):311-3. [Medline].

  2. Sjo NC, Buchwald CV, Cassonnet P, et al. Human papillomavirus in normal conjunctival tissue and in conjunctival papilloma. Types and frequencies in a large series. Br J Ophthalmol. 2006 Dec 13. [Medline].

  3. Minchiotti S, Masucci L, Serapiao Dos Santos M, Perrella E, Graffeo R, Lambiase A. Conjunctival papilloma and human papillomavirus: identification of HPV types by PCR. Eur J Ophthalmol. 2006 May-Jun. 16(3):473-7. [Medline].

  4. Egbert JE, Kersten RC. Female genital tract papillomavirus in conjunctival papillomas of infancy. Am J Ophthalmol. 1997 Apr. 123(4):551-2. [Medline].

  5. Lauer SA. Recurrent conjunctival papilloma causing nasolacrimal duct obstruction. Am J Ophthalmol. 1990 Nov 15. 110(5):580-1. [Medline].

  6. Migliori ME, Putterman AM. Recurrent conjunctival papilloma causing nasolacrimal duct obstruction. Am J Ophthalmol. 1990 Jul 15. 110(1):17-22. [Medline].

  7. Petrelli R, Cotlier E, Robins S, Stoessel K. Dinitrochlorobenzene immunotherapy of recurrent squamous papilloma of the conjunctiva. Ophthalmology. 1981 Dec. 88(12):1221-5. [Medline].

  8. Lass JH, Foster CS, Grove AS, et al. Interferon-alpha therapy of recurrent conjunctival papillomas. Am J Ophthalmol. 1987 Mar 15. 103(3 Pt 1):294-301. [Medline].

  9. Muralidhar R, Sudan R, Bajaj MS, Sharma V. Topical interferon alpha-2b as an adjunctive therapy in recurrent conjunctival papilloma. Int Ophthalmol. 2009 Feb. 29(1):61-2. [Medline].

  10. de Keizer RJ, de Wolff-Rouendaal D. Topical alpha-interferon in recurrent conjunctival papilloma. Acta Ophthalmol Scand. 2003 Apr. 81(2):193-6. [Medline].

  11. Falco LA, Gruosso PJ, Skolnick K, Bejar L. Topical interferon alpha 2 beta therapy in the management of conjunctival papilloma. Optometry. 2007 Apr. 78(4):162-6. [Medline].

  12. Hawkins AS, Yu J, Hamming NA, Rubenstein JB. Treatment of recurrent conjunctival papillomatosis with mitomycin C. Am J Ophthalmol. 1999 Nov. 128(5):638-40. [Medline].

  13. Shields CL, Lally MR, Singh AD, et al. Oral cimetidine (Tagamet) for recalcitrant, diffuse conjunctival papillomatosis. Am J Ophthalmol. 1999 Sep. 128(3):362-4. [Medline].

  14. Chang SW, Huang ZL. Oral cimetidine adjuvant therapy for recalcitrant, diffuse conjunctival papillomatosis. Cornea. 2006 Jul. 25(6):687-90. [Medline].

  15. Schachat A, Iliff WJ, Kashima HK. Carbon dioxide laser therapy of recurrent squamous papilloma of the conjunctiva. Ophthalmic Surg. 1982 Nov. 13(11):916-8. [Medline].

  16. Jackson WB, Beraja R, Codere F. Laser therapy of conjunctival papillomas. Can J Ophthalmol. 1987 Feb. 22(1):45-7. [Medline].

  17. Bailey RN, Guethlein ME. Diagnosis and management of conjunctival papillomas. J Am Optom Assoc. 1990 May. 61(5):405-12. [Medline].

  18. Bosniak SL, Novick NL, Sachs ME. Treatment of recurrent squamous papillomata of the conjunctiva by carbon dioxide laser vaporization. Ophthalmology. 1986 Aug. 93(8):1078-82. [Medline].

  19. Buggage RR, Smith JA, Shen D, Chan CC. Conjunctival papillomas caused by human papillomavirus type 33. Arch Ophthalmol. 2002 Feb. 120(2):202-4. [Medline].

  20. Campbell RJ. Tumors of the eyelids, conjunctiva, and cornea. Garner A, Klintworth GK, eds. Pathobiology of Ocular Disease - A Dynamic Approach. Marcel Dekker Inc; 1994. 1367-8(chap 46).

  21. Chang T, Chapman B, Heathcote JG. Inverted mucoepidermoid papilloma of the conjunctiva. Can J Ophthalmol. 1993 Jun. 28(4):184-6. [Medline].

  22. Chiemchaisri Y, Dongosintr N, Wasi C, et al. The regression of recurrent conjunctival papillomas by lymphoblastoid interferon treatment. J Med Assoc Thai. 1990 Jul. 73(7):406-13. [Medline].

  23. Eagle RC. Conjunctiva. Eye Pathology - An Atlas and Basic Text. Philadelphia, Pa: WB Saunders Co; 1999. 47-8, 59, 61-2(chap 4).

  24. Easty DL, Williams C. Viral and rickettsial disease. Garner A, Klintworth GK, eds. Pathobiology of Ocular Disease - A Dynamic Approach. Marcel Dekker Inc; 1994. 247(chap 7).

  25. Harkey ME, Metz HS. Cryotherapy of conjunctival papillomata. Am J Ophthalmol. 1968 Nov. 66(5):872-4. [Medline].

  26. Hsu HC, Lin HF. Eyelid tumors in children: a clinicopathologic study of a 10-year review in southern Taiwan. Ophthalmologica. 2004 Jul-Aug. 218(4):274-7. [Medline].

  27. Jakobiec FA, Harrison W, Aronian D. Inverted mucoepidermoid papillomas of the epibulbar conjunctiva. Ophthalmology. 1987 Mar. 94(3):283-7. [Medline].

  28. Khalil MK, Pierson RB, Mihalovits H, et al. Intraepithelial neoplasia of the bulbar conjunctiva clinically presenting as diffuse papillomatosis. Can J Ophthalmol. 1993 Oct. 28(6):287-90. [Medline].

  29. Kremer I, Sandbank J, Weinberger D, et al. Pigmented epithelial tumours of the conjunctiva. Br J Ophthalmol. 1992 May. 76(5):294-6. [Medline].

  30. Lass JH, Grove AS, Papale JJ, et al. Detection of human papillomavirus DNA sequences in conjunctival papilloma. Am J Ophthalmol. 1983 Nov. 96(5):670-4. [Medline].

  31. Lass JH, Jenson AB, Papale JJ, Albert DM. Papillomavirus in human conjunctival papillomas. Am J Ophthalmol. 1983 Mar. 95(3):364-8. [Medline].

  32. Mantyjarvi M, Syrjanen S, Kaipiainen S, et al. Detection of human papillomavirus type 11 DNA in a conjunctival squamous cell papilloma by in situ hybridization with biotinylated probes. Acta Ophthalmol (Copenh). 1989 Aug. 67(4):425-9. [Medline].

  33. Margo CE, Mack WP. Therapeutic decisions involving disparate clinical outcomes: patient preference survey for treatment of central retinal artery occlusion. Ophthalmology. 1996 Apr. 103(4):691-6. [Medline].

  34. McDonnell JM, Lass JH. Human papillomavirus diseases. Pepose JS, et al, eds. Ocular Infection and Immunity. New York: Mosby; 1996. 857-68(chap 67).

  35. McDonnell JM, McDonnell PJ, Mounts P, et al. Demonstration of papillomavirus capsid antigen in human conjunctival neoplasia. Arch Ophthalmol. 1986 Dec. 104(12):1801-5. [Medline].

  36. McDonnell PJ, McDonnell JM, Kessis T, et al. Detection of human papillomavirus type 6/11 DNA in conjunctival papillomas by in situ hybridization with radioactive probes. Hum Pathol. 1987 Nov. 18(11):1115-9. [Medline].

  37. McLean IW, et al. Tumors of the conjunctiva (Chapter 3). In: Tumors of the Eye and Ocular Adnexa. Atlas of Tumor Pathology. Washington, DC: Armed Forces Institute of Pathology. 1994:49-52.

  38. Mincione GP, Taddei GL, Wolovsky M, et al. Detection of human papillomavirus (HPV) DNA type 6/11 in a conjunctival papilloma by in situ hybridization with biotinylated probes. Pathologica. 1992 Jul-Aug. 84(1092):483-8. [Medline].

  39. Miyagawa M, Hayasaka S, Nagaoka S, Mihara M. Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma. Ophthalmologica. 1994. 208(1):46-8. [Medline].

  40. Morsman CD. Spontaneous regression of a conjunctival intraepithelial neoplastic tumor. Arch Ophthalmol. 1989 Oct. 107(10):1490-1. [Medline].

  41. Omohundro JM, Elliott JH. Cryotherapy of conjunctival papilloma. Arch Ophthalmol. 1970 Nov. 84(5):609-10. [Medline].

  42. Pfister H, Fuchs PG, Volcker HE. Human papillomavirus DNA in conjunctival papilloma. Graefes Arch Clin Exp Ophthalmol. 1985. 223(3):164-7. [Medline].

  43. Rumelt S, Pe'er J, Rubin PA. The clinicopathological spectrum of benign peripunctal tumours. Graefes Arch Clin Exp Ophthalmol. 2005 Feb. 243(2):113-9. [Medline].

  44. Saegusa M, Takano Y, Hashimura M, et al. HPV type 16 in conjunctival and junctional papilloma, dysplasia, and squamous cell carcinoma. J Clin Pathol. 1995 Dec. 48(12):1106-10. [Medline].

  45. Schechter BA, Rand WJ, Velazquez GE, et al. Treatment of conjunctival papillomata with topical interferon Alfa-2b. Am J Ophthalmol. 2002 Aug. 134(2):268-70. [Medline].

  46. Slade CS, Katz NN, Whitmore PV, Bardenstein DS. Conjunctival and canalicular papillomas and ichthyosis vulgaris. Ann Ophthalmol. 1988 Jul. 20(7):251-5. [Medline].

  47. Spencer WH. Neoplasms and related conditions (Chapter 2). In: Ophthalmic Pathology - An Atlas and Textbook. Vol. 1. Philadelphia, Pa: WB Saunders Co. 1996:106-11.

  48. Wells GB, Lasner TM, Yousem DM, Zager EL. Lhermitte-Duclos disease and Cowden's syndrome in an adolescent patient. Case report. J Neurosurg. 1994 Jul. 81(1):133-6. [Medline].

  49. Wilson FM, Ostler HB. Conjunctival papillomas in siblings. Am J Ophthalmol. 1974 Jan. 77(1):103-7. [Medline].

  50. Yanoff M, Fine BS. Conjunctiva - pseudocancerous lesions. Ocular Pathology. 4th ed. New York: Mosby-Wolfe; 1996. 220-1(chap 7).

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.