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Photo courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 9-year-old white male child was referred for a second opinion for a congested limbal mass, which was present for the past 7 yers. He complained of intermittent episodes of irritation and itching in the affected eye. On examination, visual acuity was 6/6 in both eyes. Right eye, anterior segment examination revealed a 5.0x2.6x1.5mm limbal mass as shown above. The rest of the examination was within normal limits in both eyes.

1.	What is your clinical diagnosis?
	b -- conjunctival nevus The lesion is an amelanotic conjunctival nevus; the cysts within the lesion are quite suggestive of the diagnosis.
2.	The treatment advised would be:
	b -- observation and excision biopsy, if lesion grows further If the lesion shows growth potential on follow up visits, the lesion needs excision by NO TOUCH technique, including 1.5 - 2 mm of normal conjunctiva around the lesion. A triple freeze thaw cycle of cryotherapy is done after excision biopsy.

References:

1. Shields CL, Demirci H, Kartaza E, et al. Clinical survey of 1643 melanocytic and non-melanocytic tumors of the conjunctiva. Ophthalmology 2004, 111:49:3-24.
2. Shields CL, Fasiudden A, Mashayekhi A, et al. Conjunctival nevi: clinical features and natural course in 410 consecutive patients. Arch Ophthalmol 2004, 122:167-175.