A Rare Presentation of Actinic Keratosis Affecting the Tarsal Conjunctiva and Review of the Literature

We report an unusual case of actinic keratosis (AK) of the tarsal conjunctiva in a 63-year-old man. Examination revealed a crusty, leukoplakic lesion prone to bleeding on the tarsal conjunctiva of the right upper eyelid. This was treated by surgical excisional biopsy. At 1-year follow-up, there was no evidence of recurrence and the surgical site was completely healed without conjunctival scarring. Current opinion cites excessive exposure to ultraviolet (UV) radiation, in particular UV-B in sunlight, as the causative agent in developing AK. In the case we present, the tarsal conjunctiva is an unusual place for actinic keratosis due to the lack of direct UV-light exposure. The key learning points are to evert the upper eyelid during examination especially if the lesion involves the eyelid margin and, secondly, to ensure risk factors are addressed during the history.