Review Article

Diagnosis and staging of ocular surface squamous neoplasia

Roland Höllhumer, Pamela Michelow, Susan Williams
African Vision and Eye Health | Vol 79, No 1 | a590 | DOI: | © 2020 Roland Hollhumer | This work is licensed under CC Attribution 4.0
Submitted: 25 June 2020 | Published: 14 December 2020

About the author(s)

Roland Höllhumer, Department of Ophthalmology, Faculty of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa; and, The Cornea Foundation, Johannesburg, South Africa
Pamela Michelow, Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Susan Williams, Department of Ophthalmology, Faculty of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa


Background: Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour. The diagnosis of OSSN is based on clinical suspicion and confirmed by various diagnostic modalities, of which histology is the gold standard. With the move to less invasive management options such as topical chemo- or immunotherapy, less invasive diagnostic options have come to the fore.

Aim: The purpose of this article was to review the current staging and diagnostic modalities for OSSN with a focus on less invasive modalities.

Method: A literature review was performed for publications on ocular surface neoplasia and diagnostic modalities.

Results: Histology is the gold standard for diagnosing OSSN. Cytology has been shown to be a simple, repeatable and minimally invasive diagnostic modality, which also allows for additional testing such as polymerase chain reaction. Anterior segment optical coherence tomography provides a non-contact method of evaluating the ocular surface, with OSSN showing a thickened hyper-reflective epithelium, abrupt transition zone and demarcation line. Vital dyes are used less commonly with high sensitivity, but lower specificity for OSSN. Finally, confocal microscopy provides en-face images of the ocular surface, with OSSN showing a classic ‘starry night’ appearance.

Conclusion: Histology remains the gold standard for diagnosis; however, with the increasing use of topical therapy for OSSN, there has been an increase in the uptake of less invasive diagnostic modalities.


conjunctival neoplasm; squamous cell cancer; conjunctival imprint cytology; liquid-based cytology; conjunctival histology; optical coherence tomography; confocal microscopy; methylene blue; toluidine blue; ultrasound biomicroscopy


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Crossref Citations

1. Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa
Roland Hӧllhumer, Pamela Michelow, Susan Williams
Eye  year: 2023  
doi: 10.1038/s41433-023-02833-0