Ocular surface squamous neoplasia (OSSN) has a varied presentation. The etiopathogenesis is still not clearly understood, although various factors such as exposure to UV rays, viral infections and chemical carcinogens have been implicated. The number of patients with human immunodeficiency virus has increased which is reflected in an increase of this tumor with a poorer prognosis. Anterior segment OCT and confocal microscopy have become powerful tools to aid the diagnosis of OSSN.