Abstract
Lesions of the caruncle are uncommon. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. Clinical preoperative diagnosis is very difficult and reached only in about half of the cases. The vast majority of lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare but can be potentially fatal. Although malignancy is clinically overestimated, any suspected malignant lesion should be excised and examined histopathologically by an experienced pathologist. This study presents the clinical and histological data of 42 consecutive caruncular lesions processed at our laboratory and reviews previously reported cases of caruncular lesions.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Bron AJ, Tripathi RC, Tripathi BJ . Wolff's Anatomy of the Eye and Orbit, 18th edn. Chapman and Hall Medical: Spain, 1997 pp 70–71.
Pe’er J, Maly A, Deckel Y, Frenkel S . Solitary fibrous tumor of the conjunctiva. Arch Ophthalmol 2007; 125: 423–426.
Shields CL, Shields JA . Tumors of the caruncle. Int Ophthalmol Clin 1993; 33: 31–36.
Kathuria SS, Howarth D, Hurwitz JJ, Oestreicher J . An anatomic and histologic study of the caruncle. Ophthal Plast Reconstr Surg 1999; 15: 407–411.
von Graefe A . Geschwülste der Tränenkarunkel. Arch Ophthalmol 1854; 1: 289–291.
Serra GM . Tumori della caruncola lacrimale. Studio clinico ed anatomo patologico-casistica. Boll Ocul 1928; 7: 783–802.
Evans WH . Tumors of the lacrimal caruncle. A study of 200 collected cases. Arch Ophthalmol 1940; 24: 83–106.
Wilson RP . Tumours and cysts of the lacrimal caruncle. Trans Ophthalmol Soc N Z 1959; 11: 23–32.
Luthra CL, Doxanas MT, Green WR . Lesions of the caruncle: a clinicohistopathologic study. Surv Ophthalmol 1978; 23: 183–195.
Shields CL, Shields JA, White D, Augsburger JJ . Types and frequency of lesions of the caruncle. Am J Ophthalmol 1986; 102: 771–778.
Santos A, Gómez-Leal A . Lesions of the lacrimal caruncle. Clinicopathologic features. Ophthalmology 1994; 101: 943–949.
Østergard J, Prause JU, Heegaard S . Caruncular lesions in Denmark 1978–2002: a histopatholgical study with correlation to clinical referral diagnosis. Acta Ophthalmol Scand 2006; 84: 130–136.
Kaeser PF, Uffer S, Zografos L, Hamédani M . Tumors of the caruncle: a clinicopathologic correlation. Am J Ophthalmol 2006; 142: 448–455.
Mansour K, van Bijsterveld OP . Supernumerary caruncle: report of a case. Ann Ophthalmol 1984; 16: 677–678.
Duke-Elder S . Congenital anomalies of the ocular adnexa: the eyelids. In: Duke-Elder S (ed). System of Ophthalmology. Henry Kimpton: London, England, 1964; 861–862.
Zamir E, Banin E, Chowers I, Arnon N, Pe’er J . Ectopic caruncle. Arch Ophthalmol 1999; 117: 1446–1447.
Nirankari MS, Chaddah MR . Supernumerary punctum on the caruncle. Br J Ophthalmol 1962; 46: 380–381.
Mansour K, Versteegh M, Janssen A, Blanksma L . Epiphora due to compression of the lacrimal sac by a supernumerary blind sac. Orbit 2002; 21: 43–47.
Nijhawan N, Morad Y, Seigel-Bartelt J, Levin AV . Caruncle abnormalities in the oculo-auriculo-vertebral spectrum. Am J Med Genet 2002; 113: 320–325.
Ghafouri A, Rodgers IR, Perry HD . A caruncular dermoid with contiguous eyelid involvement: embryologic implications. Ophthal Plast Reconstr Surg 1998; 14: 375–377.
Koo L, Chang EL . Methicillin-resistant Staphylococcus aureus caruncle abscess. Ophthal Plast Reconstr Surg 2007; 23: 160–161.
D’Hermies F, Validire P, Meyer A, Morel X, Halhal M, Elmaleh C et al. Inflammatory pseudotumor of the caruncle. J Fr Ophtalmol 2003; 26: 204–207.
Murube J, Chenzhuo L, Murube E, Rivas L, Shalaby O . Measuring the lacunar sulci as a new indicator of shrinkage of the ocular surface. Eur J Ophthalmol 2001; 11: 227–232.
España-Gregori E, Vera-Sempere FJ, Cano-Parra J, Ramos-Fernandez V, Navea-Tejerina A, DÃaz-Llopis M . Cytomegalovirus infection of the caruncle in the acquired immunodeficiency syndrome. Am J Ophthalmol 1994; 117: 406–407.
Vannas S, Lapinleimu K . Molluscum contagiosum in the skin, caruncle, and conjunctiva: detection of a cytopathic agent in tissue culture. Acta Ophthalmol (Copenh) 1967; 45: 314–321.
Kini U, Babu MK . Ocular spherulocystosis. J Clin Pathol 1996; 49: 857–858.
Polderman AM, Manschot WA . Armillifer armillatus located within the lacrimal caruncle. Acta Leiden 1979; 47: 71–77.
Gallardo MJ, Randleman JB, Price KM, Johnson DA, Acosta S, Grossniklaus HE et al. Ocular argyrosis after long-term self-application of eyelash tint. Am J Ophthalmol 2006; 141: 198–200.
Spencer WH . Conjunctiva. In: Spencer WH (ed). Ophthalmic Pathology: An Atlas and Textbook. WB Saunders: Philadelphia, 1996; 97.
Dhir SP, Shishku MN, Krewi A . Ocular horn. Br J Ophthalmol 1989; 73: 317–318.
Sjö NC, Heegaard S, Prause JU, von Buchald C, Lindeberg H . Human papillomavirus in conjunctival papilloma. Br J Ophthalmol 2001; 85: 785–787.
Sjö NC, Heegaard S, Prause JU . Conjunctival papilloma. A histopathologically based retrospective study. Acta Ophthalmol Scand 2000; 78: 663–666.
de Keizer RJW, de Wolff-Rouendaal D . Topical α-interferon in recurrent conjunctival papilloma. Acta Ophthalmol Scand 2003; 81: 193–196.
Streeten BW, Carrillo R, Jamison R, Brownstein S, Font RL, Zimmerman LE . Inverted papilloma of the conjunctiva. Am J Ophthalmol 1979; 88: 1062–1066.
Hodak E, Jones RE, Ackerman AB . Solitary keratoacanthoma is a squamous-cell carcinoma: three examples with metastases. Am J Dermatopathol 1993; 15: 332–342; discussion 343–352.
Rossman D, Arthurs B, Odashiro A, Saraiva V, Burnier Jr M . Basal cell carcinoma of the caruncle. Ophthal Plast Reconstr Surg 2006; 22: 313–314.
stergaard J, Boberg-Ans J, Prause JU, Heegaard S . Primary basal cell carcinoma of the caruncle with seeding to the conjunctiva. Graefes Arch Clin Exp Ophthalmol 2005; 243: 615–618.
Meier P, Sterker I, Meier T . Primary basal cell carcinoma of the caruncle. Arch Ophthalmol 1998; 116: 1373–1374.
Poon A, Sloan B, McKelvie P, Davies R . Primary basal cell carcinoma of the caruncle. Arch Ophthalmol 1997; 115: 1585–1587.
MencÃa-Gutiérrez E, Gutiérrez-DÃaz E, Pérez-MartÃn ME . Lacrimal caruncle primary basal cell carcinoma: case report and review. J Cutan Pathol 2005; 32: 502–505.
Lindgren G, Lindblom B, Larkö O . Mohs’ micrographic surgery for basal cell carcinomas on the eyelids and medical canthal area. II. Reconstruction and follow-up. Acta Ophthalmol Scand 2000; 78: 430–436.
Dithmar S, Schütt F, Völcker HE . Papillary plica/caruncle tumor. Squamous epithelial carcinoma of the conjunctiva associated with human papillomavirus type 16. Ophthalmologe 2002; 99: 118–119.
Nylander AG, Atta HR . Adenosquamous carcinoma of the lacrimal caruncle: a case report. Br J Ophthalmol 1986; 70: 864–866.
Rodman RC, Frueh BR, Elner VM . Mucoepidermoid carcinoma of the caruncle. Am J Ophthalmol 1997; 123: 564–565.
Lam DS, To KF, Fan DS, Cheuk W . An uncommon malignant neoplasm of the caruncle: report of a case of undifferentiated carcinoma. Arch Ophthalmol 1998; 116: 374–376.
Bowyer J, Sullivan T, Whitehead K . Steatocystoma simplex of the caruncle. Br J Ophthalmol 2003; 87: 240–241.
Kim NJ, Moon KC, Khwarg SI . Steatocystoma simplex of the caruncle. Can J Ophthalmol 2006; 41: 83–85.
Norn M . Pigmentation of plica and lacrymal caruncle. Prevalence among Caucasians, Eskimos, and Japanese. Acta Ophthalmol (Copenh) 1984; 62: 939–943.
Shields CL, Fasiuddin AF, Mashayekhi A, Shields JA . Conjunctival nevi: clinical features and natural course in 410 consecutive patients. Arch Ophthalmol 2004; 122: 167–175.
Gerner N, Nørregaard JC, Jensen OA, Prause JU . Conjunctival naevi in Denmark 1960–1980. A 21-year follow-up study. Acta Ophthalmol Scand 1996; 74: 334–337.
Shields CL, Demirci H, Karatza E, Shields JA . Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology 2004; 111: 1747–1754.
Jakobiec FA, Folberg R, Iwamoto T . Clinicopathologic characteristics of premalignant and malignant melanocytic lesions of the conjunctiva. Ophthalmology 1989; 96: 147–166.
Shields JA, Shields CL, Mashayekhi A, Marr BP, Benavides R, Thangappan A et al. Primary acquired melanosis of the conjunctiva: risks for progression to melanoma in 311 eyes. The 2006 Lorenz E. Zimmerman lecture. Ophthalmology 2008; 115: 511–519.
Hamilton RS . Two cases of malignant melanoma of the lids, conjunctiva, and caruncle. Trans Am Ophthalmol Soc 1968; 66: 394–415.
Paridaens AD, Minassian DC, McCartney AC, Hungerford JL . Prognostic factors in primary malignant melanoma of the conjunctiva: a clinicopathological study of 256 cases. Br J Ophthalmol 1994; 78: 252–259.
Anastassiou G, Heiligenhaus A, Bechrakis N, Bader E, Bornfeld N, Steuhl KP . Prognostic value of clinical and histopathological parameters in conjunctival melanomas: a retrospective study. Br J Ophthalmol 2002; 86: 163–167.
Shields CL . Conjunctival melanoma. Br J Ophthalmol 2002; 86: 127.
Shields CL, Shields JA, Gündüz K, Cater J, Mercado GV, Gross N et al. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Arch Ophthalmol 2000; 118: 1497–1507.
Zimmerman LE, Maumenee AE, Reese AB . Discussion of pigmented tumors of the conjunctiva. In: Boniuk M (ed). Ocular and Adnexal Tumors. C.V. Mosby Company: St Louis, 1964.
Kodjikian L, Devouassoux M, Grange JD . Pigmented tumors of the caruncle. Review of the literature. J Fr Ophtalmol 1999; 22: 688–699.
Massry GG, Holds JB, Kincaid MC, Patrinely JR . Sebaceous gland hyperplasia of the caruncle. Ophthal Plast Reconstr Surg 1995; 11: 32–36.
Shields JA, Shields CL, Marr BP, Eagle Jr RC . Sebaceous carcinoma of the caruncle. Cornea 2006; 25: 858–859.
Shields JA, Demirci H, Marr BP, Eagle Jr RC, Shields CL . Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology 2004; 111: 2151–2157.
Shields JA, Demirci H, Marr BP, Eagle Jr RC, Stefanyszyn M, Shields CL . Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture. Ophthal Plast Reconstr Surg 2005; 21: 92–96.
Shields JA, Demirci H, Marr BP, Eagle Jr RC, Shields CL . Sebaceous carcinoma of the ocular region: a review. Surv Ophthalmol 2005; 50: 103–122.
Rennie IG . Oncocytomas (oxyphil adenomas) of the lacrimal caruncle. Br J Ophthalmol 1980; 64: 935–939.
Shields CL, Shields JA, Arbizo V, Augsburger JJ . Oncocytoma of the caruncle. Am J Ophthalmol 1986; 102: 315–319.
Morgan MB, Truitt CA, Romer C, Somach S, Pitha JV . Ocular adnexal oncocytoma: a case series and clinicopathologic review of the literature. Am J Dermatopathol 1998; 20: 487–490.
Rodgers IR, Jakobiec FA, Krebs W, Hornblass A, Gingold MP . Papillary oncocytoma of the eyelid. A previously undescribed tumor of apocrine gland origin. Ophthalmology 1988; 95: 1071–1076.
George E, Swanson PE, Newman BK, Wick MR . Oculocutaneous oncocytic tumors: clinicopathologic and immunohistochemical study of 2 cases with literature review. Am J Dermatopathol 2007; 29: 279–285.
Duke TG, Fahy GT, Brown LJ . Malignant apocrine sweat gland carcinoma of the caruncle. Orbit 2000; 19: 7–11.
Shields CL, Shields JA, Carvalho C, Rundle P, Smith AF . Conjunctival lymphoid tumors: clinical analysis of 117 cases and relationship to systemic lymphoma. Ophthalmology 2001; 108: 979–984.
Cockerham GC, Jakobiec FA . Lymphoproliferative disorders of the ocular adnexa. Int Ophthalmol Clin 1997; 37: 39–59.
Coupland SE, Krause L, Delecluse HJ, Anagnostopoulos I, Foss HD, Hummel M et al. Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases. Ophthalmology 1998; 105: 1430–1441.
Tang J, Rodgers IR, Basham KL, Goh J . Rare case of exuberant benign lymphoid hyperplasia involving the conjunctiva, caruncle, and plica in a child with tonsilar enlargement. J AAPOS 2003; 7: 293–294.
Telander DG, Lee TZ, Pambuccian SE, Huang AJ . Subconjunctival corticosteroids for benign lymphoid hyperplasia. Br J Ophthalmol 2005; 89: 770–771.
Reddy S, Finger PT, Chynn EW, Iacob CE . Reactive lymphoid hyperplasia 1 month after LASIK surgery. Graefes Arch Clin Exp Ophthalmol 2006; 244: 262–264.
Chang YC, Chang CH, Liu YT, Tsai KB, Liu TC, Lin YN . Spontaneous regression of a large-cell lymphoma in the conjunctiva and orbit. Ophthal Plast Reconstr Surg 2004; 20: 461–463.
Kiratli H, Kocabeyoğlu S, Sağlam A, Söylemezoğlu F . Langerhans cell histiocytosis of the caruncle. Clin Experiment Ophthalmol 2007; 35: 661–663.
Stanowsky A, Krey HF, Wagner T . Histiocytosis X (eosinophilic granuloma) of the caruncle. Klin Monatsbl Augenheilkd 1991; 199: 359–361.
Yaghouti F, Nouri M, Mannor GE . Ocular adnexal granulocytic sarcoma as the first sign of acute myelogenous leukemia relapse. Am J Ophthalmol 1999; 127: 361–363.
Kafil-Hussain N, Khooshabeh R, Graham C . Superficial adnexal lymphangioma. Orbit 2005; 24: 141–143.
Hirsch C, Holz FG, Tetz M, Völcker HE . Clinical aspects and histopathology of caruncular tumors. Klin Monatsbl Augenheilkd 1997; 210: 153–157.
Freedman KA, Tran RM . Neurofibroma involving the caruncle. Arch Ophthalmol 2004; 122: 294–295.
Rennie IG, Parsons MA, Benson MT . Neurilemoma of the caruncle: a clinicopathological report. Br J Ophthalmol 1991; 75: 749–751.
Carney JA . Carney complex: the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas. Semin Dermatol 1995; 14: 90–98.
Evans M, Chang E, Yu DL, Rao NA . Granular cell tumour: a rare caruncle lesion. Br J Ophthalmol 2006; 90: 246–247.
Heegaard S, Prause JU . Leiomyoma of the caruncle. Acta Ophthalmol Scand 1998; 76: 731–733.
Allaire GS, Corriveau C, Teboul N . Malignant fibrous histiocytoma of the conjunctiva. Arch Ophthalmol 1999; 117: 685–687.
Gritz DC, Rao NA . Metastatic carcinoid tumor diagnosis from a caruncular mass. Am J Ophthalmol 1991; 112: 470–472.
Lie A, Mooy C, van den Bosch W, Paridaens D . Caruncle tumor as the first sign of metastatic lung carcinoma. Am J Ophthalmol 2002; 134: 438–439.
Kiratli H, Shields CL, Shields JA, DePotter P . Metastatic tumours to the conjunctiva: report of 10 cases. Br J Ophthalmol 1996; 80: 5–8.
Acknowledgements
We thank Mr Israel Barzel for the clinical pictures of the patients.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Levy, J., Ilsar, M., Deckel, Y. et al. Lesions of the caruncle: a description of 42 cases and a review of the literature. Eye 23, 1004–1018 (2009). https://doi.org/10.1038/eye.2008.316
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2008.316
Keywords
This article is cited by
-
A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years
Eye (2024)
-
Malignant lesions of the caruncle
Eye (2023)
-
Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital
Journal of Epidemiology and Global Health (2022)
-
Clinico-pathological correlation of lacrimal caruncle tumors: a retrospective analysis over 22Â years at the University Eye Hospital Bonn
Graefe's Archive for Clinical and Experimental Ophthalmology (2022)
-
Primäres Basalzellkarzinom der Karunkel
Der Ophthalmologe (2019)


