Pediatric conjunctival papilloma managed with staged multimodal therapy: a case report.

Abstract

Background: Conjunctival papilloma is a rare benign ocular surface tumor in children, most commonly associated with low-risk human papillomavirus types 6 and 11. Management can be challenging because of multifocal disease, persistence, recurrence, and the need to preserve healthy conjunctival tissue in young patients. We report a pediatric case of multifocal conjunctival papilloma successfully managed with a staged multimodal approach combining preoperative medical therapy with limited surgical excision.

Case presentation: A 4-year-old boy presented with multifocal conjunctival papillomatous lesions. Following clinical evaluation and diagnosis of conjunctival papilloma, preoperative topical and intralesional interferon alfa-2b were administered to reduce the lesion size. Residual lesions were subsequently treated with limited surgical excision following preoperative interferon-mediated debulking and intraoperative application of mitomycin C. The patient had a favorable clinical course, with preservation and progressive restoration of the conjunctival architecture. At 2 years of follow-up, there was no evidence of recurrence.

Conclusions: This case highlights the potential value of a staged multimodal strategy for managing multifocal conjunctival papilloma in children. Preoperative medical debulking followed by targeted surgical excision may help reduce the extent of surgery, preserve healthy conjunctival tissue, and achieve durable disease control. This approach may be particularly useful in pediatric ocular surface disease, where tissue preservation is an important consideration.