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July/August 2011

 
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Surprising Papilloma Excision

I enjoyed reading “Liquid Nitrogen Cryotherapy for Ocular Surface Disease” (January, Clinical Update), especially the discussion about the value of liquid nitrogen in treating conditions like pterygia and hemangiomas.

I recently examined a patient with papillomatous viral conjunctivitis, involving the medial canthal area, that had invaded the lower lid punctum. It did not respond to liquid nitrogen freezing. I applied the nitrogen directly to the lesion using a saturated Q-tip until a definite circular ice-ball occurred. I then removed the Q-tip, the tissue thawed and I performed a repeat freeze and thaw. At follow-ups of one day and one month, there was no change.

I elected to partially excise the papilloma but did not include the punctum. For several months following the dissection, the papilloma spontaneously regressed and disappeared—even the untreated punctal area was free of disease.

Papillomas do have a propensity to evolve. The expression “mother wart” is an accurate one. Taking off one or several warts can trigger an immune response to the virus and generate total body rejection.

A colleague related a case of a patient with 15 warts in various skin areas. Following excision of one large plantar wart, all of the other 14 untreated papillomas became inflamed and sloughed off. During the rejection phase, her foot was so painful that she could not walk for several days.

J. Terrence Coyle, MD   
Bellevue, Wash.    

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Correction

In the article “Handle Avastin and Lucentis With Care” (News in Review, May), the caption was incorrectly edited to say that the microparticle in the photo is a silicone oil microdroplet. The caption should have said that the sample of repackaged bevacizumab contains a contaminant of unknown origin that is 111 ?m in length. EyeNet regrets the error.

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