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A prospective study of the incidence, associations and outcomes of ocular surface squamous neoplasia in the United Kingdom

Eyevolume 33pages283294 (2019) | Download Citation

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. 1.

    Assess the incidence and demographic profile of patients presenting with OSSN in the United Kingdom during a 12-month period, based on a prospective observational study.

  2. 2.

    Evaluate the clinical presentation of and risk factors associated with OSSN in the United Kingdom during a 12-month period, based on a prospective observational study.

  3. 3.

    Determine management and prognosis of OSSN in the UK during a 12-month period, based on a prospective observational study.

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All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at; (4) view/print certificate.

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Release date: 28 December 2018;

Expiration date: 28 December 2019

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Authors/Editor disclosure information

Sobha Sivaprasad has disclosed the following relevant financial relationships: Served as an advisor or consultant for Allergan, Bayer, Boehringer Ingelheim, Novartis, Heidelberg, Optos. Served as a speaker or a member of a speakers bureau for Bayer, Allergan, Novartis, Optos. Received grants for clinical research from Bayer, Boehringer Ingelheim, Allergan, Novartis, Optos. H.H. has disclosed the following relevant financial relationships: Served as a speaker or a member of a speakers bureau for Alcon, Alimera, Bausch and Lomb, Bayer AG. C.A.K., R.M.K.S., S.S., S.B.K., and B.D. have disclosed no relevant financial relationships.

Journal CME author disclosure information

Laurie Barclay has disclosed the following relevant financial relationships: Owns stock, stock options, or bonds from: Pfizer Inc.



To describe the incidence, associations and outcomes of ocular surface squamous neoplasia (OSSN) in the United Kingdom.


Prospective, observational study of every new case of OSSN reported via the British Ophthalmological Surveillance Unit reporting scheme over a 12-month period. Cases were followed up for 12 months.


The reported incidence of OSSN was 0.53 cases/million/year (conjunctival intraepithelial neoplasia: 0.43 cases/million/year; squamous cell carcinoma: 0.08 cases/million/year). Eighty-five per cent of affected patients were male, 97% were Caucasian, and the mean age at presentation was 67.9 (±12.8) years. Information on potential underlying risk factors was frequently unknown. The most commonly affected sites were the limbus and the nasal and temporal bulbar conjunctivae. Most patients presented with a visual acuity of 6/9 or better, without symptoms of pain or visual loss. Excision (with or without additional treatment) was the most common first-line treatment and interferon (with or without additional treatment) was the most common second-line treatment, although management varied widely. Complications of treatment were rare but occasionally severe. Recurrence within 12 months of follow-up occurred in at least 6% of patients.


Although subject to reporting bias, these data suggest that there has not been a significant change in the incidence of OSSN in the United Kingdom, or its demographic profile, since 1996. The broad range of management approaches identified in this study reflect a lack of consensus as to the optimal referral and treatment pathways.

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We would like to acknowledge and sincerely thank all the ophthalmologists who contributed to this study by reporting cases via the British Ophthalmological Surveillance Unit (BOSU) scheme. This work would not have been possible without their valuable input and support of this project. We would also like to express our gratitude to the BOSU and the Royal College of Ophthalmologists who provided us with this opportunity to study the epidemiology of ocular surface squamous neoplasia on a national scale.


Funding for this study was obtained via a grant from the Oxfordshire Health Services Research Committee. This was supplemented by a grant that the British Ophthalmological Surveillance Unit holds from the Iris Fund for the Prevention of Blindness.

Author information


  1. Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    • Christine A. Kiire
  2. St Paul’s Eye Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK

    • Rosalind M. K. Stewart
    • , Heinrich Heimann
    •  & Stephen B. Kaye
  3. Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK

    • Rosalind M. K. Stewart
    • , Heinrich Heimann
    •  & Stephen B. Kaye
  4. Department of Ophthalmology, University Hospital Ayr, Ayr, UK

    • Sathish Srinivasan
  5. University of Glasgow, Glasgow, Scotland, UK

    • Sathish Srinivasan
  6. School of Clinical Sciences, University of Edinburgh, Edinburgh, UK

    • Baljean Dhillon


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The authors declare that they have no conflict of interest.

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Correspondence to Christine A. Kiire.

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