Conjunctival keloid is a rare, benign ocular condition characterized by the excessive growth of scar tissue on the conjunctiva, the clear membrane covering the white of the eye and the inner surface of the eyelids. Unlike normal scars that stabilize over time, a keloid continues to grow beyond the original area of injury due to prolonged collagen deposition, leading to a raised, firm, and often pink-to-pale mass on the ocular surface. Microscopically, these lesions demonstrate thickened, disorganized bundles of collagen fibers—primarily types I and III—resulting from an abnormal wound-healing response where fibroblast activity and transforming growth factor‑β signaling remain persistently elevated EyeWikiNCBI.
Conjunctival keloids, also known as conjunctival fibrosis, are rare benign lesions characterized by an overgrowth of fibrous scar tissue on the conjunctiva—the thin, transparent membrane covering the white part of the eye and lining the inside of the eyelids. They typically arise after surgical trauma (e.g., pterygium excision, strabismus surgery, glaucoma filtration procedures) or severe ocular injury (chemical burns, mechanical trauma) and may also occur in the setting of chronic inflammation, such as allergic or autoimmune conjunctivitis. Histologically, conjunctival keloids exhibit excessive collagen deposition and fibroblast proliferation, extending beyond the original wound boundaries, which can lead to ocular irritation (itching, burning, foreign-body sensation), visual disturbances (blurred vision, induced astigmatism when near the visual axis), and cosmetic concerns (raised, discolored conjunctival nodules). Diagnosis is based on slit-lamp examination, visual acuity testing, and, when necessary, biopsy to differentiate from nevi, papillomas, or malignancies. Management aims to relieve symptoms, restore vision, and address cosmesis while minimizing recurrence. EyeWiki
Clinically, conjunctival keloids present as smooth, firm nodules or plaques that may be pedunculated (attached by a narrow stalk) or sessile (broad-based), often appearing weeks to years after conjunctival trauma or surgery. They can vary in size from a few millimeters to several centimeters, sometimes causing cosmetic concern, irritation, or vision disturbance if they encroach upon the visual axis. Histopathological examination following biopsy is essential to differentiate keloids from hypertrophic scars, cysts, or neoplasms, confirming the overgrowth of hyalinized collagen without significant myofibroblast proliferation ResearchGateEyeWiki.
Types of Conjunctival Keloids
1. Congenital Conjunctival Keloid
Present at birth or identified in early infancy without any preceding trauma, congenital keloids likely arise from developmental anomalies in collagen regulation. They are exceedingly rare and may be associated with syndromic conditions affecting connective tissue development PMC.
2. Primary (Idiopathic) Conjunctival Keloid
These keloids develop spontaneously in the absence of any apparent injury or surgical history. The underlying mechanism is thought to involve a localized imbalance in collagen turnover and growth factor signaling within the conjunctiva itself NCBI.
3. Secondary (Traumatic/Surgical) Conjunctival Keloid
The most common type, arising at sites of previous surgery (e.g., pterygium excision, strabismus surgery) or after ocular trauma such as lacerations, burns, or chemical injuries. Surgical manipulation triggers an exaggerated fibroblastic response, leading to keloid formation over weeks to months EyeWiki.
4. Pedunculated Conjunctival Keloid
Characterized by a narrow stalk attaching the keloid mass to the underlying conjunctiva. This morphological variant can be mobile and may cause mechanical irritation of the ocular surface ResearchGate.
5. Sessile Conjunctival Keloid
Broad-based lesions that fuse directly with the conjunctival surface, often more stable but potentially more difficult to excise completely due to their wider attachment EyeWiki.
6. Localized Conjunctival Keloid
Small, well-circumscribed nodules typically less than 5 mm in diameter, often asymptomatic and sometimes incidentally discovered during routine eye examinations EyeWiki.
7. Diffuse Conjunctival Keloid
Larger, poorly defined areas of scarring that may involve multiple quadrants of the conjunctiva, potentially leading to significant ocular surface distortion and vision impairment EyeWiki.
Causes
Genetic Predisposition: Family history of keloids suggests inherited abnormalities in collagen regulation and fibroblast activity EyeWikiNCBI.
Surgical Trauma: Procedures such as pterygium removal or strabismus surgery can precipitate keloid formation at the incision site EyeWiki.
Mechanical Injury: Blunt trauma, eye rubbing, or foreign‐body insults can trigger an overactive healing response NCBI.
Chemical Burns: Alkali or acid exposure damages conjunctival tissue, leading to aberrant scar proliferation EyeWiki.
Thermal Burns: Heat injuries induce inflammation and collagen overproduction similar to skin keloids EyeWiki.
Chronic Inflammation: Long-standing conjunctivitis (allergic or infectious) promotes fibroblast activation EyeWiki.
Autoimmune Conditions: Diseases like ocular cicatricial pemphigoid cause repeated tissue injury and aberrant repair NYU Langone Health.
Infection: Bacterial or viral pathogens (e.g., adenovirus, HSV) can incite intense inflammation and scarring Lybrate.
Radiation Exposure: Therapeutic or environmental radiation disrupts normal healing pathways DermNet®.
Hormonal Influences: Fluctuations during puberty or pregnancy may exacerbate fibroblast proliferation NCBI.
UV Radiation: Ultraviolet light can damage conjunctival cells, leading to fibrosis over time Wikipedia.
Nutritional Deficiencies: Lack of vitamin C impairs normal collagen maturation, promoting scar overgrowth NCBI.
Tissue Hypoxia: Poor oxygenation (e.g., from contact lens overwear) can alter fibroblast behavior NCBI.
Dry Eye Disease: Repeated microtrauma from tear film instability may predispose to scarring Wikipedia.
Foreign Body Reaction: Retained ocular sutures or implants can chronically irritate the conjunctiva NCBI.
Symptoms
Itching: Keloid tissue often irritates nerve endings, causing persistent itching. EyeWiki
Burning Sensation: Fibrous nodules may produce a warm, burning feeling on the eye surface. EyeWiki
Foreign Body Sensation: Patients frequently report feeling a “lump” or grit under the eyelid. EyeWiki
Redness: Localized hyperemia around the lesion results from increased blood flow. Wikipedia
Tearing (Epiphora): Obstruction or irritation of the tear film can lead to excessive watering. Cleveland Clinic
Photophobia: Light sensitivity occurs if the keloid encroaches upon the limbus or cornea. Wikipedia
Blurred Vision: Encroachment on the visual axis or induced astigmatism degrades clarity. EyeWiki
Astigmatism: Irregular conjunctival elevation can alter corneal curvature and refractive power. EyeWiki
Ocular Pain: Although uncommon, larger keloids can cause mild pain or discomfort. Medical News Today
Cosmetic Disfigurement: Visible masses on the white of the eye may distress patients. EyeWiki
Diagnostic Tests
Physical Examination
Visual Acuity Test: Measures clarity of vision to assess impact on sight. EyeWiki
Slit-Lamp Biomicroscopy: Detailed magnified view of the conjunctival lesion under adjustable illumination. EyeWikiWikipedia
External Inspection: Evaluation of eyelid and bulbar conjunctiva for lesion morphology and color. Wikipedia
Palpation: Gentle pressure applied to assess firmness and mobility of the mass. Wikipedia
Eyelid Eversion: Flipping the eyelid to examine palpebral conjunctiva for hidden extensions. Wikipedia
Manual Tests
Retinoscopy: Objective assessment of refractive error and induced astigmatism by the lesion. Wikipedia
Subjective Refraction (Phoropter): Fine-tunes the corrective lens prescription affected by keloid‐induced distortion. Wikipedia Wikipedia
Keratometry: Measures corneal curvature to detect astigmatism from conjunctival elevation. Wikipedia
Laboratory and Pathological Tests
Conjunctival Swab Culture: Identifies bacterial or fungal pathogens contributing to inflammation. Lybrate
Conjunctival Biopsy & Histopathology: Gold standard; reveals hyalinized collagen bundles typical of keloid. EyeWiki
Immunohistochemical Staining: Detects collagen types I and III to confirm keloid versus hypertrophic scar. ResearchGate
PCR for Viral Pathogens: Excludes viral causes (e.g., herpes, chlamydia) in differential diagnosis. Akron Children’s Hospital
Complete Blood Count (CBC): Screens for systemic inflammatory or hematologic abnormalities. Wikipedia
Electrodiagnostic Tests
Electrooculography (EOG): Measures corneo‑retinal potential to rule out retinal pigment epithelium dysfunction. Wikipedia
Electromyography (EMG) of Orbicularis Oculi: Evaluates muscle involvement if spasm or discomfort is reported. Wikipedia
Imaging Tests
External Slit-Lamp Photography: Documents lesion size, shape, and response over time using camera attachment. Verywell Health
Anterior Segment Optical Coherence Tomography (AS-OCT): High‑resolution cross‑sectional images of conjunctival and corneal interfaces. EyeWiki
Ultrasound Biomicroscopy (UBM): Uses high-frequency ultrasound to visualize lesion depth and involvement of underlying structures. Wikipedia
B-Scan Ocular Ultrasonography: Assesses deeper orbital extension when the keloid mass is large or indurated. EyeWikiMedscape
Magnetic Resonance Imaging (MRI) of the Orbit: Evaluates extra‑conjunctival spread and rule out malignancy when indicated. Wikipedia
Non‑Pharmacological Treatments
Supportive, non‑drug interventions can complement medical and surgical approaches by modulating wound healing, reducing inflammation, and empowering patients through self‑care.
Exercise Therapies
Ocular Massage
Gentle, circular massage over the eyelid and adjacent conjunctiva performed for 1–2 minutes twice daily can stimulate tissue pliability, promote lymphatic drainage, and reduce collagen cross‑linking, helping to soften keloid tissue over time.Eyelid Blink Exercises
Repetitive full blinks (20 blinks per session, three sessions daily) improve tear film distribution and mechanical micro‑stimulation of the conjunctival surface, which may modulate fibroblast activity and maintain tissue elasticity.Extraocular Muscle Stretching
In patients with post‑strabismus surgery keloids, gentle stretching of the extraocular muscles (holding gaze in end‑range positions for 10 seconds, five times each direction) may reduce local tension on the conjunctiva and discourage fibrotic overgrowth.Warm Compresses
Application of a warm (40 °C) compress for 5–10 minutes twice daily enhances local blood flow, facilitates collagen remodeling through heat‑induced enzyme activation, and alleviates discomfort.Cold Compresses
Intermittent cold packs (5 minutes every 2 hours as needed) can reduce acute inflammatory mediators in early keloid formation by vasoconstriction and slowing fibroblast proliferation.Targeted Facial Yoga
Exercises that involve upward gaze and eyebrow lifts may indirectly stretch the nasal and temporal conjunctiva, potentially mitigating perilesional tension and promoting balanced collagen deposition.Neck and Posture Alignment
Maintaining proper head and neck posture reduces gravitational stress on the anterior ocular surface, possibly decreasing mechanical triggers for keloid progression.
Mind‑Body Therapies
Guided Relaxation
Daily 10‑minute guided breathing and muscle‑relaxation exercises lower systemic cortisol levels, which in excess can exacerbate fibrosis through TGF‑β upregulation.Biofeedback Training
Using simple home biofeedback devices to monitor and reduce sympathetic arousal may attenuate pro‑fibrotic inflammatory pathways.Mindfulness Meditation
Regular mindfulness (20 minutes daily) can modulate neuroimmune interactions, decreasing pro‑inflammatory cytokines that contribute to aberrant scar formation.Progressive Muscle Relaxation
Systematically tensing and releasing facial and neck muscles may improve local circulation and reduce chronic low‑grade inflammation around the orbit.Yoga Nidra
Deep relaxation practice for 30 minutes nightly supports balanced autonomic function and may indirectly influence wound‑healing mediators.Guided Imagery
Visualization techniques focusing on healthy tissue regeneration can psychologically support adherence to adjunctive therapies and reduce stress‑induced flare‑ups.Cognitive Behavioral Strategies
Techniques to reduce eye‑rubbing and anxiety around keloid appearance can minimize mechanical insults and stress‑mediated inflammatory signaling.
Educational Self‑Management
Symptom Diary Keeping
Recording ocular symptoms, sleep quality, and triggers empowers patients to identify factors (allergens, environmental irritants) that worsen inflammation.Surgical Aftercare Instruction
Detailed guidance on postoperative cleansing, drop application, and activity restrictions reduces complications and recurrence.Allergen Avoidance Education
Identifying and minimizing exposure to allergens (dust, animal dander) helps control chronic conjunctival inflammation.Sunlight Protection Training
Use of UV‑blocking sunglasses lowers UV‑induced conjunctival cytokine release that can fuel fibrotic responses.Lifestyle Modification Counseling
Emphasizing smoking cessation, adequate hydration, and balanced nutrition supports optimal wound healing at a molecular level.Support Group Participation
Connecting with others who have experienced ocular scarring fosters adherence to long‑term management plans and reduces anxiety.
Pharmacological Treatments
Evidence‑based medications can target inflammation, cell proliferation, and collagen synthesis to shrink keloids or prevent recurrence.
Intralesional Triamcinolone Acetonide (Corticosteroid)
Inject 10 mg/mL into the keloid every 4–6 weeks (up to 4 sessions) to inhibit fibroblast activity and collagen deposition. Side effects include ocular hypertension, cataract formation, and localized depigmentation. EyeWikiPerilesional Dexamethasone (Corticosteroid)
Administer 4 mg/mL weekly for 3–4 weeks to reduce inflammation. Potential adverse effects are similar to triamcinolone with additional risk of delayed wound healing.Intralesional 5‑Fluorouracil (5‑FU) (Antimetabolite)
Inject 50–150 mg weekly (up to 16 injections) to selectively inhibit collagen synthesis and TGF‑β signaling. Common side effects include injection‑site pain, ulceration, and hyperpigmentation. MDPITopical Mitomycin C (Alkylating Agent)
Apply 0.02% solution for 3 minutes post‑excision to prevent fibroblast proliferation. Risks include ocular surface toxicity (epithelial defects, delayed healing). MDPIIntralesional Interferon Alpha‑2b (Immunomodulator)
Inject 1.5 million IU weekly for 4 weeks to inhibit fibroblast proliferation and modulate immune response. Side effects: flu‑like symptoms, injection discomfort. MDPIIntralesional Bevacizumab (Anti‑VEGF Antibody)
Inject 1.25 mg monthly for 2 months to reduce vascular supply to the keloid, limiting nutrient delivery. Side effects: risk of hemorrhage, pain at injection site.Intralesional Bleomycin (Antitumor Antibiotic)
Inject 0.1 mg/cm² lesion area every 4 weeks; may induce local tumor‑like apoptotic effects in fibroblasts. Side effects: pain, local hyperpigmentation. MDPITopical Enalapril Cream (ACE Inhibitor)
Apply 1% cream daily for 3 months to downregulate TGF‑β activity and collagen deposition. Side effects: local irritation. MDPIOral Tranilast (Anti‑Allergy Agent)
100 mg three times daily; inhibits TGF‑β release from mast cells, reducing fibrosis. Side effects: gastrointestinal upset, hepatotoxicity. MDPIIntralesional Botulinum Toxin A (Neuromodulator)
Inject 2.5 units monthly for 3 sessions to decrease muscle tension and fibroblast activation. Side effects: localized muscle weakness, injection‑site discomfort. MDPI
Dietary Molecular Supplements
Adjunctive nutraceuticals may modulate fibrotic pathways and oxidative stress.
Vitamin D₃ (Cholecalciferol)
2,000 IU orally daily; reduces keloid fibroblast proliferation and collagen I expression, induces apoptosis via caspase‑3 activation PMC.Curcumin
Topical 2% gel twice daily for 8–12 weeks; inhibits TGF‑β1/Smad signaling and reduces ECM synthesis. Clinical studies report a 30–40% reduction in scar thickness. FrontiersQuercetin
500 mg orally daily; decreases fibroblast proliferation and collagen I levels, induces fibroblast apoptosis. PMCAllicin
600 mg garlic extract daily; inhibits fibroblast migration in scratch assays, reducing keloid formation. PLOSCaffeine
200 mg daily; suppresses keloid fibroblast migration and proliferation in vitro. PLOSCentella Asiatica (Asiaticoside)
60 mg three times daily; normalizes fibroblast behavior by suppressing TGF‑β1 and VEGF, balancing MMP/TIMP activity. FrontiersEGCG (Green Tea Polyphenol)
Topical 1% application daily; inhibits Akt/PI3K and ERK/MAPK pathways, reducing collagen gene expression. FrontiersBerberine
500 mg orally twice daily; promotes macrophage M1→M2 shift, reducing pro‑fibrotic cytokines. FrontiersResveratrol
500 mg orally daily; antioxidant that scavenges ROS and inhibits NF‑κB‑mediated cytokine release. FrontiersAloe Vera Gel
Topical application twice daily; improves hydration, suppresses inflammation, and enhances scar elasticity. Frontiers
Regenerative and Stem‑Cell‑Based Therapies
Emerging cell‑based approaches harness growth factors and paracrine signaling for scar remodeling.
Platelet‑Rich Plasma (PRP)
Inject autologous PRP concentrate (3–5× platelet count) into the lesion monthly for 3 sessions; delivers growth factors (PDGF, VEGF, TGF‑β) to modulate fibroblast activity and promote balanced ECM remodeling. WikipediaResearchGateMesenchymal Stem Cell Transplantation (MSC)
Inject 1×10⁶ MSCs per cm² lesion area; cells secrete anti‑inflammatory and anti‑fibrotic cytokines, inhibiting keloid fibroblast proliferation and promoting normal tissue repair. PMCAdipose‑Derived Stem Cells (ASCs)
Inject ASCs suspension monthly for 3 months; improves scar color, elasticity, and thickness by secreting paracrine factors that downregulate collagen synthesis. FrontiersMSC‑Conditioned Media (MSC‑CM)
Inject 0.5 mL of MSC‑CM weekly for 4 weeks; contains exosomes and growth factors that reduce inflammation and fibrosis. Wiley Online LibraryADSC‑Derived Exosomes (ADSC‑Exos)
Inject 50 µg protein exosome preparation monthly; exosomal microRNAs modulate iron metabolism and attenuate fibrotic pathways in keloid tissue. FrontiersUmbilical Cord‑Derived MSCs (UC‑MSCs)
Intralesional injection of UC‑MSCs (1×10⁶ cells) monthly; superior to steroid for volume reduction, these cells exert potent immunomodulatory and anti‑fibrotic effects. Wiley Online Library
Surgical Options
When conservative measures fail, surgery can debulk tissue; adjunctive techniques reduce recurrence.
Simple Excision
Surgical removal of the keloid under local anesthesia; provides immediate debulking but has a high recurrence rate (70–100% when used alone). EyeWikiExcision with Conjunctival Autograft
After lesion removal, transplant healthy conjunctiva from the superior bulbar area to the defect; lowers recurrence (to <10%) by replacing scar‑prone tissue. PMCExcision with Amniotic Membrane Transplantation
Overlay preserved amniotic membrane post‑excision; its anti‑inflammatory and anti‑fibrotic properties promote healing and reduce scar formation. PubMedSuperficial Keratectomy
Technique for corneal‑involving keloids: blade‑based removal of superficial stromal tissue; clears opacity while preserving corneal integrity. BioMed CentralPenetrating Keratoplasty
Full‑thickness corneal transplantation for extensive corneal keloid involvement; restores corneal clarity but requires lifelong graft monitoring. ScienceDirect
Preventive Measures
Avoid unnecessary ocular surgeries in predisposed individuals. EyeWiki
Use meticulous surgical techniques to minimize conjunctival trauma.
Apply perioperative topical mitomycin C after conjunctival surgery. MDPI
Control chronic conjunctival inflammation (e.g., treat allergies promptly). EyeWiki
Wear UV‑blocking sunglasses outdoors.
Maintain smoking cessation to optimize wound healing. Wikipedia
Use lubricating eye drops to prevent dryness and microtrauma. EyeWiki
Educate on gentle eyelid hygiene to avoid mechanical irritation.
Monitor vitamin D levels and supplement if deficient. Karger
Avoid chemical exposures (harsh cleansers, industrial fumes).
When to See a Doctor
Seek prompt ophthalmologic evaluation if you notice any new or enlarging raised conjunctival lesion, persistent eye irritation lasting more than two weeks, blurred vision, significant discomfort, bleeding, or cosmetic distress. Early assessment can differentiate keloids from malignancies and facilitate timely management. EyeWiki
What to Do—and What to Avoid
Do
Keep the ocular surface well‑lubricated.
Apply warm compresses to ease discomfort.
Use prescribed anti‑inflammatory drops as directed.
Wear protective eyewear during activities that risk trauma.
Follow postoperative instructions meticulously.
Keep a symptom diary to track triggers.
Adhere to follow‑up appointments.
Practice stress‑reduction techniques to modulate healing.
Maintain balanced nutrition and hydration.
Wear UV protection outdoors.
Avoid
Rubbing or scratching the eye.
Smoking or exposure to second‑hand smoke. Wikipedia
Unsupervised use of corticosteroid or chemotherapeutic eye drops.
Prolonged contact lens wear if irritation occurs.
Inadvertent chemical exposures to the eye.
Skipping prescribed injection or drop regimens.
Excessive sun exposure.
Using non‑sterile eyewash solutions.
High‑impact sports without eye protection.
Delaying evaluation of lesion changes.
Frequently Asked Questions
What exactly is a conjunctival keloid?
A conjunctival keloid is an overgrowth of fibrous scar tissue on the eye’s conjunctiva, resembling skin keloids but occurring on the ocular surface. EyeWikiHow common are conjunctival keloids?
They are very rare, with only a few hundred cases reported in the literature.What causes them?
Surgical trauma, severe injury, chronic inflammation, and genetic predisposition can all trigger conjunctival keloid formation. EyeWikiCan they be cancerous?
No—conjunctival keloids are benign fibrotic lesions, but biopsy may be needed to rule out malignancy.How are they diagnosed?
Diagnosis involves slit‑lamp examination, visual acuity testing, and occasionally biopsy to confirm benign collagen proliferation. EyeWikiWill they recur after removal?
Recurrence rates are high (up to 70–100%) if excision is performed alone; adjunctive therapies (steroids, mitomycin C, radiation) can reduce recurrence. EyeWikiAre eye drops enough to treat them?
Lubricating drops relieve irritation but do not shrink established keloids; anti‑inflammatory injections or surgery are typically required. EyeWikiIs radiation therapy safe for the eye?
Low‑dose radiation after excision can prevent recurrence but carries risks (dry eye, cataract if misapplied) and is used selectively. EyeWikiCan nutrition affect healing?
Adequate vitamin D, protein, and antioxidants support normal wound healing and may reduce keloid risk. KargerAre there home remedies?
Supportive measures (cold/warm compresses, gentle massage, sun protection) can help but will not eliminate keloids.When is surgery indicated?
Surgery is considered for functional impairment (vision axis involvement), severe irritation, or significant cosmetic concern. EyeWikiWhat is the role of stem cells?
MSC and PRP therapies are investigational but show promise in remodeling fibrotic tissue and improving outcomes. PMCResearchGateCan stress make keloids worse?
Chronic stress elevates cortisol and inflammatory cytokines, potentially exacerbating fibrotic processes; stress management is beneficial.How soon after surgery can I get drops or injections?
Typically 2–4 weeks post‑excision, once the wound is stable, to reduce recurrence risk.Should I avoid sun exposure after surgery?
Yes—UV light can induce inflammation and should be minimized with protective eyewear and sunscreen around the eyes.
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Last Updated: July 19, 2025.
