Stevens-Johnson Syndrome : Stevens-Johnson syndrome (also termed erythema multiforme major) is an acute, inflammatory, vesiculobullous reaction of the skin and mucous membranes. It occurs most commonly in children and young adults, and it is more prevalent in females. Patients develop the acute onset of fever, arthralgia, malaise, and upper or lower respiratory tract symptoms. A cutaneous eruption typically follows within a few days, and in classic cases a “target” lesion appears, although maculopapular or bullous lesions are also common. Bullous eruptions with membrane or pseudomembrane formation occur on mucous membranes, including those of the eyes, mouth, and genitalia. A mucopurelent conjunctival discharge is common. Cutaneous and ocular involvement continues for approximately 4 to 6 weeks. Late ocular complications can include conjunctival symblephara, Trichiasis, and dry eye. Management of the acute phase of Stevens-Johnson syndrome can consist of topical steroids (if infection is not present), topical antibiotics to prevent secondary infection, and frequent lubrication. Chronic management is aimed at controlling dry eye changes, eyelid margin keratinization, Trichiasis, and non-healing corneal epithelial defects.

Conjunctival Nevus : Conjunctival nevi are congenital hamartomas that consist of nests of modified melanocytes (nevus cells). Junctional, compound, and subepithelial nevi occur in the conjunctiva. The subepithelial nevus of the conjunctiva is the equivalent of the dermal nevus of the skin. An important variation in the conjunctiva is the frequent occurrence of small epithelial inclusion cysts within nevi, particularly within compound or subepithelial ones. Pigmentation of conjunctival nevi is variable. They are often light tan and relatively amelanotic. Conjunctival nevi rarely undergo malignant transformation. If they enlarge or develop changes in pigmentation, excision is recommended.

Adrenochrome Deposits: Conjunctival or corneal darkly pigmented deposits can occur in patients who are using topical epinephrine compounds for glaucoma. These pigment deposits are composed of oxidized epinephrine and occur between the epithelial basement membrane and Bowman’s layer in the cornea or in epithelial cysts in the conjunctiva. Adrenochrome deposits are generally harmless and rarely require cessation of the drug.

Pinguecula: A pinguecula is a degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus in the interpalpebral zone, most often nasally. Pingueculae have the appearance of yellow-white amorphous, subepithelial deposits, and they may gradually enlarge over time. The principal histopathologic finding is a fragmented and curled appearance of the subepithelial collagen fibers. These fibers often have a basophilic histologic appearance with hematoxylineosin staining; they also stain with elastic tissue stains. This type of collagen degeneration has been termed elastoid or elastotic degeneration. Excision of a pinguecula is indicated only if the lesion constitutes a cosmetic problem, or if it becomes chronically inflamed or interferes with contact lens wear.