The use of high resolution optical coherence tomography (HR-OCT) in the diagnosis of ocular surface masqueraders

Despoina Theotoka, Sarah Wall, Anat Galor, Wathanee Sripawadkul, Rayan Abou Khzam, Vincent Tang, Dubovy L. Sander, Carol L. Karp

Research output: Contribution to journalReview articlepeer-review


Introduction: Ocular surface masqueraders encompass any ocular surface lesion masquerading as another ocular surface lesion. High resolution optical coherence tomography (HR-OCT) has emerged as an adjunctive tool to clinical acumen. This study's purpose is to evaluate the utility of HR-OCT images in guiding the diagnosis and management of those lesions. Material and methods: 22 individuals with a clinically ambiguous ocular surface lesion with slit lamp photographs (SLP), HR-OCT images, and histopathological examination were included in the study. The presumptive clinical diagnosis based on SLP was compared to the diagnosis suggested by HR-OCT findings and to definitive diagnosis by histopathology. The main outcome of this study was the frequency in which HR-OCT findings guided the clinician to the correct diagnosis. Results: 7 lesions were epithelial, 3 had an epithelial and a subepithelial component, and 12 were subepithelial. HR-OCT was most effective in discerning lesion location, successfully identifying the location in 100% of cases. Classic HR-OCT findings were detected in 68.2% of cases while suggestive features were detected in 31.8% of cases. The epithelial lesions' mean epithelial thickness was 265.4 ± 140.6 μm, the subepithelial lesions' mean was 58.0 ± 25.0 μm, and the combined lesions’ mean was 140.0 ± 70.0 μm. The epithelium was significantly thicker in epithelial lesions compared to subepithelial and combined lesions. By ROC analysis we identified that using a cut off of 156 μm, the sensitivity was 86% and the specificity was 93%. Discussion: HR-OCT can be a valuable diagnostic tool, assisting in the differentiation of ambiguous ocular surface pathologies by providing a cross-sectional, morphological image of the lesion.

Original languageEnglish (US)
Pages (from-to)74-82
Number of pages9
JournalOcular Surface
StatePublished - Apr 2022
Externally publishedYes


  • Amyloid
  • Classic
  • Epithelial
  • HR-OCT
  • Lymphoma
  • Masquerade
  • Melanoma
  • Ocular surface
  • Ocular surface squamous neoplasia
  • Squamous cell carcinoma
  • Subepithelial

ASJC Scopus subject areas

  • Ophthalmology


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