Background <p>The purpose of this retrospective study was to analyze the features of different ocular surface lesions using high resolution swept-source optical coherence tomography (OCT) and to correlate those characteristics with histopathologic alterations.</p> Methods <p>Thirty-eight eyes of 37 patients (19 males and 18 females) were included in this study with a mean age of 60.36 ± 17.29 years years. Anterior segment imaging was performed with a swept-light source OCT system (ANTERION, Heidelberg Engineering, Germany) using the Imaging App. Clinical diagnosis based on the slit-lamp findings was compared with the OCT features of the lesion and the histopathology result.</p> Results <p>Based on the OCT features, 11 lesions were in the epithelium, of which 5 had only epithelial component. Six growths had both epithelial and subepithelial components and 27 lesions were confined to the substantia propria. The OCT finding and histopathology result correlated in 57% (6/11) for epithelial involvement and in 84% (28/33) for subepithelial involvement. In 25 cases (65%), the clinical and histopathology diagnosis agreed. In 13 cases (35%), the clinical suspicion was different from the final histopathology diagnosis. Out of those 13 cases, high-resolution OCT findings were suggestive of the histopathology results in 8 cases.</p> Conclusions <p>High-resolution swept-source OCT provided valuable information of the structure, topographic location and extent of an ocular surface lesion and was helpful in assisting the diagnosis.</p>