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Clinical profile, histopathology, and management of caruncular lesions; a systematic review

Eye volume 39, pages 424–435 (2025)Cite this article

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Abstract

Background

The lacrimal caruncle, a nodular structure located at the inner canthus, contains a variety of tissue types, leading to diverse clinical manifestations of its lesions. Caruncular lesions, though rare, may be benign or malignant, complicating diagnosis and treatment. This systematic review aims to provide a comprehensive overview of the clinical profiles, histopathological features, and management strategies for caruncular lesions.

Methods

This was a PROSPERO-registered (CRD42024529956), PRISMA guideline-adherent systematic review. Databases searched include PubMed, Scopus, and CINAHL Ultimate from inception to June 29, 2024. Grey literature was also searched. Studies involving patients diagnosed with caruncular lesions were included. A novel classification strategy has been developed and proposed.

Results

From an initial 1602 articles, 16 studies were included, representing a range of demographics and clinical features. Histopathological diagnosis varied widely, with benign lesions more common than malignant ones. Common benign lesions included nevi, papillomas, and pyogenic granulomas, while malignant lesions included basal cell carcinomas, sebaceous cell carcinomas, and melanomas. Medical management often combined topical therapies with surgical excision. Surgical management primarily involved excision, with some cases necessitating more radical procedures, which were typically reserved for extensive or malignant lesions. Recurrence was noted in several studies, with melanomas being at the highest risk of recurrence.

Conclusion

Caruncular lesions exhibit diverse histopathological profiles, necessitating a combination of clinical and histopathological examination for accurate diagnosis and management. Early detection and appropriate management are crucial for improving patient outcomes. Despite the rarity of these lesions, their potential malignancy and systemic metastasis create a need for prospective studies.

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Authors and Affiliations

  1. Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India

    H. Shafeeq Ahmed, Samyuktha Vinu Nair, Mohammed Sulaiman Sache, Rishika Das, Aryan Gupta, Sakshi C. Choradia, Likitha Prakash, Priyamvada Bangre Praveen, Prajwal Gowda, Sneha Gupta, C. H. Sai Bharath, Deepak B. Shivananda & Chinmayee J. Thrishulamurthy

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Contributions

HSA conceived and designed the study. Literature review and screening were conducted by HSA and DBS. Data extraction was performed by SVN, MSS, and RD, while data analysis and interpretation were undertaken by SVN, HSA, AG, and SCC. Quality assessment was performed by PBP which was validated by HSA and DBS. HSA, AG, SCC, LP, PG, SG, and CHSB contributed to writing and editing the manuscript. Supervision was provided by CJT and HSA. All authors reviewed and approved the final version of the manuscript.

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Correspondence to H. Shafeeq Ahmed.

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Ahmed, H.S., Nair, S.V., Sache, M.S. et al. Clinical profile, histopathology, and management of caruncular lesions; a systematic review. Eye 39, 424–435 (2025). https://doi.org/10.1038/s41433-024-03560-w

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