title: Conjunctival Intraepithelial Neoplasia with Mucoepidermoid Differentiation: A Case Report of a Subtle Lesion.
abstract: OBJECTIVE
  To describe the clinical presentation, diagnostic imaging, and treatment options of conjunctival intraepithelial neoplasia (CIN) with mucoepidermoid differentiation, an in situ stage of mucoepidermoid carcinoma of the conjunctiva (MCC).
  
  
  RESULTS
  We report the case of an 86-year-old man presenting with a subtle limbal lesion that had only mild erythema and elevation. Based on a few atypical clinical features and an abnormal ultrahigh-resolution optical coherence tomography (UHR OCT), an incisional biopsy was performed revealing CIN with mucoepidermoid differentiation. Treatment involved aggressive surgical excision. No evidence of recurrence was noted in the 5 years of follow-up.
  
  
  CONCLUSIONS
  MCC is an aggressive tumor that has a tendency to be invasive and recur after treatment. Therefore, early diagnosis and treatment is critical. CIN with mucoepidermoid differentiation may represent the earliest stage of MCC. It can present subtly, with a clinical resemblance to benign and less aggressive ocular surface lesions. Imaging with UHR OCT may be helpful to detect early neoplasia. A high level of suspicion must be maintained when evaluating potential ocular surface tumors.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA.
authors.forename: Madhura G
authors.initials: MG
authors.lastname: Joag
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Miami Veterans Affairs Medical Center, Miami, Fla., USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Florida Lions Eye Bank, Ocular Pathology Laboratory, Miami, Fla., USA.
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Florida Lions Eye Bank, Ocular Pathology Laboratory, Miami, Fla., USA.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Bermudez-Magner
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Wang
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
keywords: Conjunctival intraepithelial neoplasia; Imaging; Mucoepidermoid differentiation; Neoplasia; Optical coherence tomography