Rare Conjunctival Venous Malformation Removed After 20-Year Growth

A 40-year-old man who had lived with a painless red mass on his right conjunctiva for roughly two decades has been diagnosed with an isolated cavernous venous malformation, an extraordinarily rare benign vascular lesion at this site. The case, published in BMC Ophthalmology, describes how a lesion that had remained stable for many years began gradually enlarging over the preceding five years, prompting the patient to seek surgical removal for cosmetic reasons.

Cavernous venous malformations, historically called cavernous hemangiomas, are benign lesions made up of large, thin-walled vascular channels. They are commonly found in the orbit, the bony cavity that houses the eye, but isolated involvement of the conjunctiva, the thin transparent membrane covering the front of the eye and lining the eyelids, is described as extremely rare. Because these lesions can resemble other vascular growths, the authors emphasize that careful clinical evaluation, imaging, and histopathological examination are essential to establish the diagnosis and to rule out extension into the eye or orbit.

On examination, the mass was vascularized, red, elevated, and non-tender, measuring approximately 1 by 1.2 millimeters over the temporal bulbar conjunctiva, the portion of the membrane covering the white of the eye on the outer side. Surrounding conjunctival and episcleral vessels were engorged. The lesion was soft and non-mobile, and several bedside tests helped characterize its vascular nature: it showed no pulsation, no change in size during the Valsalva maneuver, and no blanching after topical application of 2.5% phenylephrine, findings that helped distinguish it from lesions that empty under pressure or vary with venous flow.

Imaging played a decisive role in defining the lesion’s boundaries. Ultrasound biomicroscopy, a high-frequency technique that images the anterior segment at high resolution, demonstrated that the mass was confined to the conjunctiva without scleral or intraocular extension. B-scan ultrasonography of the deeper structures showed no posterior segment abnormality.

Given the gradual progression and the patient’s cosmetic concern, surgical removal was elected. The surgeons achieved complete excision without complications.

Under the microscope, the specimen showed multiple large, irregular vascular channels lined by a single layer of endothelial cells, the characteristic architecture of a cavernous venous malformation, embedded within hyalinized connective tissue. Immunohistochemical staining, which uses antibodies to identify specific proteins on cell surfaces, added molecular confirmation: the endothelial lining stained positive for CD31 and CD34, two standard markers of vascular endothelium, and was negative for podoplanin D2-40, a marker associated with lymphatic endothelium. This staining pattern supported a venous rather than lymphatic origin for the malformation.

The postoperative course was uneventful, and at one-year follow-up there was no evidence of recurrence. The authors conclude that isolated conjunctival cavernous venous malformation, though rare, belongs in the differential diagnosis of any slowly progressive conjunctival vascular mass. In their experience, imaging is valuable for assessing the extent of the lesion, while histopathological and immunohistochemical evaluation confirms the diagnosis, and complete surgical excision provided a favorable outcome in this patient.

The case is reported as a single-patient account, so it illustrates diagnostic reasoning rather than population-level evidence about how often such lesions occur or how they respond to treatment more broadly. Its practical message lies in the diagnostic pathway it documents: a long-standing, slowly enlarging red conjunctival mass warrants imaging to exclude deeper extension, and excision with histological and immunohistochemical confirmation can both resolve the cosmetic concern and establish the true nature of the lesion. The report was published as an open-access article in BMC Ophthalmology on 24 October 2026, and the version shared ahead of the final record is citable and carries a permanent DOI.

Subject of Research: A case report of an isolated cavernous venous malformation of the conjunctiva diagnosed by imaging and histopathology and treated with complete surgical excision.

Article Title: Isolated cavernous venous malformation of the conjunctiva: a case report

Article References: Najmi, H. H., Al Somali, A. I., Al Ibrahim, E. A., Al Sawadi, H. M., & Al Saleh, E. F. (2026). Isolated cavernous venous malformation of the conjunctiva: a case report. BMC Ophthalmology. https://doi.org/10.1186/s12886-026-05441-0

Image Credits: AI Generated

DOI: 10.1186/s12886-026-05441-0

Keywords: cavernous venous malformation, conjunctiva, case report, ophthalmology, ultrasound biomicroscopy, immunohistochemistry, CD31, CD34, vascular lesion, surgical excision, BMC Ophthalmology, Isolated