MMP9 and eye adnexa disorder: Several other mutagenic factors at the molecular level have been attributed to the pathogenesis of conjunctiva SCC, such as the telomerase-reverse-transcriptase (TERT) gene promoter [68], A-disintegrin-and-metallopeptidase-domain-3 (ADAM3), especially in high-grade lesions [69], and the overexpression of matrix-metalloproteinase-9 (MMP-9), matrix-metallopeptidase-11 (MMP-11) [70], and clusterin, which is associated with epithelial carcinogenesis in the ocular surface [71].