Prevalence and associated factors of ocular surface squamous neoplasia among patients presenting with ocular surface lesions at SPHMMC in Addis Ababa, Ethiopia

Abstract

Abstract Background: Ocular Surface Squamous Neoplasia (OSSN) is the most common tumor of the ocular surface in adults, with a notably higher reported incidence in African populations. Ultraviolet (UV) radiation exposure and HIV infection are established major risk factors. Despite its clinical significance, data on the prevalence and associated factors of OSSN in Ethiopia remain scarce. Objective: This study aimed to determine the prevalence and associated factors of OSSN among patients presenting with ocular surface lesions at the Ophthalmology Unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: An institution-based cross-sectional study was conducted from February 28, 2024, to December 4, 2025. A total of 70 consecutive patients with excised ocular surface lesions were included. Data on sociodemographic, behavioral factors, and clinical features were collected via interviews and slit-lamp examination. Histopathological analysis of excised tissue confirmed the OSSN diagnosis. Data were analyzed using SPSS version 26, employing descriptive statistics, bivariate, and multivariate logistic regression. Results: The overall prevalence of histologically confirmed OSSN among studied ocular surface lesions was 57.14% (40/70). Among OSSN cases, 77.5% (31/40) were invasive Squamous Cell Carcinoma (SCC) and 22.5% (9/40) were Conjunctival Intraepithelial Neoplasia (CIN). The mean age of participants was 44.17 years (±15.42). Multivariate analysis identified prolonged daily outdoor exposure (>6 hours) as the strongest independent risk factor (Adjusted Odds Ratio [aOR]=11.84; 95% CI: 2.12-66.21; p=0.005). Age 40-60 years was also a significant risk factor (aOR=4.23; 95% CI: 1.17-15.31; p=0.028). Retroviral infection (RVI, predominantly HIV) status showed a strong association with OSSN (aOR=10.14; 95% CI: 1.00-102.50; p=0.050). Higher educational attainment (college and above) demonstrated a protective trend (aOR=0.30; 95% CI: 0.08-1.08; p=0.065). Clinically, leukoplakic appearance and the presence of feeding vessels were common features. Conclusion: This study reveals a high prevalence of OSSN among patients with ocular surface lesions at a major Ethiopian tertiary center. Prolonged UV light exposure, middle age, and HIV infection are significant risk factors, while higher education may be protective. The findings underscore the need for public health strategies promoting sun protection, targeted screening of high-risk groups and enhanced clinical suspicion for early diagnosis and management of OSSN in Ethiopia.