Ocular Rhinosporidiosis Presenting As A Rapidly Growing Conjunctival Papilloma

Abstract

A 24 year old male, resident of Delhi, presented with complaints of a painless progressive reddish lump on the lower surface in the left eye since the past two months. On examination, a sessile 10 X 6 mm wide fleshy pink, highly vasular mass was present in the middle 2/3rd of the lower palpebral conjunctiva of the left eye. The patient was clinically diagnosed as a case of conjunctival papilloma and underwent wide surgical excision. Histopathological evaluation revealed this to be ocular rhinosporidiosis. No history suggestive of as to how the infection was acquired was obtained and other mucous memberanes were unaffected which were evaluated postoperatively to rule out other sites of inoculation. The largest reported case series of rhinosporidiosis of 462 cases in South Western India found that the disease mainly occurs in the nose and nasopharynx (81.1%), while eyes were affected in 14.2%. Many case series of ocular rhinosporidiosis from South and Southwestern India have been reported but no case reports could be found from Northern India. This case highlights the importance of histopathological evaluation of all conjunctival lesions which helps in the proper diagnosis of the case and its appropriate management. “meso-in the middle of, “-myceto-fungi and “-zoea” -animals. This is a heterogenous group of microorganisms at the animal fungal boundary. These are a small group of protists, which are mostly parasites of fish and other animals. The disease is endemic in South India, Sri Lanka, South America and Africa. It is presumed to be transmitted by exposure to the pathogen when taking a bath in stagnant water pools where animals also bathe. Traumatic auto-inoculation from one site to another is common. It affects both adults and children. Floor and inferior turbinate are the most common sites of inoculation presenting as unilateral nasal obstruction, epistaxis or rhinorrhea. Ocular rhinosporidiosis most often presents as a polypoid mass of the palpebral conjunctiva. 3 It may also present as a lacrimal sac diverticulum, 4 recurrent chalazion, 5 conjunctival cyst, 6 chronic follicular conjunctivitis in contact lens wearers, 7 peripheral keratitis, 8 scleral melting, 9 ciliary staphyloma 10 or simulate a tumour of eyelid 11 or periorbital skin. 12 The diagnosis is confirmed by histopathology of the biopsied specimen. Definitive management is wide surgical excision with wide area electrocoagulation of the lesion base. Recurrences are rare. 13 Abstract The belonged to a lower socio-economic strata and