Figure 4. A 69-year-old female with a papillomatous and gelatinous OSSN involving the conjunctiva and cornea.

(A) Slit-lamp photograph of the OSSN showing multiple abnormal blood vessels surrounding and within the lesion. White dashed arrow shows the cross-sectional cut of the OCT. (B) Cross-sectional imaging detects hyper-reflective thickened epithelium (white asterisk) with an abrupt transition from normal to abnormal (white arrow) characteristic of OSSN. The yellow line shows the bottom boundary of OSSN and sub-epithelial tissue adjacent to the tumor. The red line shows the sub-epithelial tissue (200 μm) underneath the tumor. (C) Blood flow signals are seen within the tumor, beneath the tumor as well as in the surrounding sub-epithelial tissue and epithelium adjacent to the OSSN. Note the shadow from the hyper-reflective thick lesion diminishes the blood flow signals under the central portion of the OSSN. (D) The tumor thickness map depicts the thickness of the tumor, demonstrating that it is thickest in the center. (E) Overlay of the enface angiograph with grayscale slit-lamp illustrates the vessels on the ocular surface in relation to the slit-lamp view. (F) The enface angiograph of OSSN and epithelium adjacent to OSSN shows a high density of vessels within the OSSN, in a “sea fan” pattern and no such vasculature pattern in the epithelium adjacent to the OSSN (yellow asterisk). (G) The enface angiograph 200 μm below the tumor also demonstrates dense vessels in the sub-epithelial tissue under the OSSN at the tumor edge and the sub-epithelial tissue adjacent to the OSSN. (H) The merged image from the angiographic enface images (F and G) shows the vessels within the tumor OSSN (red) and under the tumor in the sub-epithelial tissue (green).

OSSN, ocular surface squamous neoplasia. Dashed white lines (D, F, G, and H) indicate the tumor boundary. Curve dashed yellow line (D, F, G, and H) indicates the limbus.