USE CASES

COVID-19 Era: Diagnosis of a Suspicious Lesion in a Telemedicine Consultation

Ofira Zloto and Nicola Dunlop

Adnexal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK

Keywords: conjunctiva, COVID-19, dysplasia, histopathology, telemedicine

 

 

In December 2019, the first report of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia was reported in China.¹ In just a few weeks, the virus spread worldwide, leading to unforeseen consequences on every aspect of our daily working and social life, as well as to radical changes in healthcare delivery.² A few months later, on March 11, 2020, the World Health Organization declared the novel coronavirus (COVID-19) a global pandemic. During the early stages of the pandemic, most elective healthcare transitioned to virtual consultation using technology such as video or telephone to conduct visits.³ In our center, most of consultation were made via video. One such case is presented here.

We invite readers to consider our experience and comment regarding their own experiences with telehealth for ophthalmologic, as well as other diagnoses during that period.

A 28-year-old woman was seen via telemedicine-consultation regarding a 2-month lesion on the right-medial-conjunctiva. This patient reported an initial history of bleeding. On examination, she was diagnosed with conjunctival papillomatous lesion in the caruncle (Figure 1A) and referred for excisional-biopsy. Histopathology revealed conjunctival squamous-papilloma with focal-dysplasia (Figure 1B–C). Due to the risk of malignancy, she was referred for another biopsy, which was benign.

Fig. 1. Clinical signs and histopathological findings in a 28-year-old woman seen via telemedicine-consultation regarding a 2-month lesion on the right-medial-conjunctiva. A: conjunctival papillomatous lesion in the caruncle; B: conjunctival squamous-papilloma with focal-dysplasia; C: areas of focal-dysplasia.

If our patient had been made to wait for evaluation in our clinic, she probably would have arrived with a malignant lesion and not just dysplasia. Therefore, this case emphasizes the importance of telemedicine, especially during challenging times when face-to-face appointments cannot be done—such as during pandemics, or patient disabilities, or long distances to travel.

In our experience, telemedicine can be an important triage tool for new findings in order to determine if in-office evaluation is warranted. Telemedicine increases the number of people evaluated, but decreases how many patients need to get seen in the clinic.

Authors’ contributions

Dr. Zloto was responsible for conception or design of the work, data collection, data analysis and interpretation, drafting the article, final approval of the version to be published. Ms. Dunlop was responsible for conception or design of the work, data collection, critical revision of the article, final approval of the version to be published.

Acknowledgments

None.

References

1. Guo Y-R, Cao Q-D, Hong Z-S, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - An update on the status. Mil Med Res 2020;7(1):11. https://doi.org/10.1186/s40779-020-00240-0
2. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. https://doi.org/10.1016/j.jaut.2020.102433
3. Sommer AC, Blumenthal EZ. Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak. Graefes Arch Clin Exp Ophthalmol. 2020;258(11):2341–2352. https://doi.org/10.1007/s00417-020-04879-2

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