An unusual case of elastofibroma oculi

A 22-year-old female college student from the southwestern United States was first seen with progressive fluffy white growths over both corneas nasally and a history of chronic allergies and extensive sun, wind, and chlorine exposure as a competitive swimmer. The lesions were superficial, elevated, crescent-shaped, vascularized, and extended from the limbal conjunctiva onto the peripheral cornea nasally. The lesions were composed of an unencapsulated thick fibrovascular pannus with numerous fibrocytes, chronic inflammatory cells and mast cells, and abundant linear and wavy elastinophilic profiles, but no adipose tissue. Ultrastructurally, the elastinophilic structures were immature elastic fibers arranged in globules and bundles within a thick collagenous matrix. No mature elastic fibers were found. A few areas of elastotic degeneration were also found. This lesion resembled elastofibromas that have been reported more commonly in the subcapsular region and only once in the ocular region. Previous reports debated whether the elastic material in elastofibromas is derived from excessive production of elastic fibers by activated fibrocytes or from elastotic degeneration of collagen. In our case, both processes occur and are presumed to result from excessive ultraviolet radiation, wind and chlorine exposure, and perhaps, chronic inflammation; features that have been ascribed to the pathogenesis of pingueculae and pterygia.