From Diagnosis to Cure: An AS-OCT-Guided Multimodal Management of Localized OSSN

Abstract

Aims: This study reports a case of localized ocular surface squamous neoplasia (OSSN) and highlights the role of anterior segment optical coherence tomography (AS-OCT) in diagnosis, surgical planning, and postoperative surveillance. Presentation of Case: A 60-year-old male farmer presented with a small, well-defined greyish-white lesion measuring 3 × 3 mm at the nasal limbus of the right eye. Anterior segment optical coherence tomography revealed a thickened, hyperreflective epithelial lesion with an abrupt transition from normal epithelium and preservation of Bowman’s layer, suggestive of pre-invasive OSSN. The lesion was managed with wide local excision using the no-touch technique with 4 mm margins, double freeze–thaw cryotherapy, intraoperative mitomycin C (0.04%), and amniotic membrane grafting. Histopathological examination confirmed carcinoma in situ. Postoperatively, topical 5-fluorouracil 1% was administered for four weeks. Discussion: AS-OCT provided a reliable, non-invasive assessment of lesion depth and extent, which assisted in confirming epithelial confinement and guiding surgical management. The combined use of surgical excision and adjuvant chemotherapy helped reduce recurrence risk while maintaining ocular surface integrity. Conclusion: Early diagnosis supported by AS-OCT and a multimodal therapeutic approach can achieve favorable anatomical and oncological outcomes in localized OSSN.