Author’s Response to comment on: Clinicopathologic study of caruncular lesions

Dear Editor, We extend our gratitude to the authors for their valuable comments and for appreciating our manuscript on caruncular tumors.[1] First and foremost, we acknowledge the earlier study by Alam et al.,[2] which indeed represents the first Indian series on caruncular tumors, comprising 36 histopathologically proven cases. We regret the omission of their paper in our initial literature review. However, we have since addressed this oversight in our recent systematic review published in eye,[3] where their study has been duly discussed. Regarding the discrepancy in the total number of cases, we clarify that our series includes 44 histopathologically proven caruncular tumors, of which 37 cases (84.09%) were benign, five cases (11.36%) were premalignant, and two cases (4.54%) were malignant. We appreciate the opportunity to rectify any perceived inconsistencies. The authors expressed concern regarding our description of the malakoplakic lesion. To clarify, we did not state that the tumor originated from the medial rectus muscle. Rather, we described the lesion as being situated “above” the medial rectus. During surgery, we confirmed that the lesion, while originating from the caruncle, neither extended from nor originated within the medial rectus but was instead closely associated with it anatomically. This terminology reflects the proximity of the caruncle to the medial rectus and is consistent with established anatomical understanding. Shields et al.[4] have also noted that the medial rectus sheath contains fibers that penetrate the deep structures of the caruncle. The effect of these attachments is most noticeable when the eye moves medially, causing the caruncle to recess, and laterally, allowing the caruncle to become unrestrained and prominent.[5] This relationship underlines the natural association of the caruncle with the medial rectus, and we believe this should clarify any misunderstanding regarding our description. In reference to the concordance rate of 84.09% between clinical and pathological diagnoses, we emphasize that this data is presented in the third paragraph of the Results section. Specific details about misdiagnoses, such as malakoplakia being initially considered cysticercosis, a nevus suspected as malignant melanoma, and sebaceous cell hyperplasia being misdiagnosed as sebaceous cell carcinoma, are included in the respective case descriptions. Lastly, we acknowledge the constructive feedback regarding other aspects of our study, such as providing more descriptive figure legends and additional details on the hypothesis regarding hormonal influence on caruncular tumors (although this was an extrapolation of existing knowledge rather than a unique finding in our series). We find that the overall conclusions and significance of our study remain largely unchanged. We thank the editor for the opportunity to address these important points. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.