Fig. 7

Surgical excision, cryotherapy, and interferon (IFN) α-2b injection for treatment of plical and multiple bulbar conjunctival papillomas. a, b. A 6-year-old black male presented with multiple papillomatous lesions affecting the caruncle/plica (a) and bulbar conjunctiva (a, b) in the left eye since age 1. Due to the patient’s age and inability of the mother to instill topical IFN, a decision was made to treat surgically. c. Complete cryotherapy was first applied to the papilloma with the intention to minimize viral spreading during subsequent manipulation. d. Then, a second cycle of cryotherapy of the entire tumor down to its base was performed. While in frozen state, lifting of the frozen tumor-probe complex allowed for tumor excision with a ‘no touch’ technique and 2 mm margins without the need for forceps. This was followed by cautery and cryotherapy at the borders of the excised conjunctiva and Tenon’s bed, as well as IFN α-2b injection (3 MIU/0.5 ml). An amniotic membrane was sutured to close the remaining conjunctival defect. e, f. At one month after surgery, the excision sites were healing well with no visualized papillomas. The amniotic membrane was secure with interrupted vicryl sutures on the tarsal conjunctiva