Lymphoid tumors of the conjunctiva may be benign, malignant, or indeterminate. Many of these lesions have overlapping clinical and pathologic features. Approximately 20% of patients with a conjunctival lymphoid tumor have detectable extraocular lymphoma.
Lymphatic Malformations: Lymphangiectasia and Lymphangioma
Lymphangiectasia appears in the eye as irregularly dilated lymphatic channels in the bulbar conjunctiva. It may be a developmental anomaly, or it can occur following trauma or inflammation. Anomalous communication with a venule can lead to spontaneous filling of the lymphatic vessels with blood. Lymphangiectasia must be distinguished from ataxia-telangiectasia, an autosomal recessive disease in which the epibulbar and interpalpebral telangiectasia of the arteries lacks an associated lymphatic component.
Lymphangioma is the term applied when the collection of anomalous lymphatic channels has a formed rather than an amorphous appearance. Involvement can be solitary or multifocal. Often, there is a deeper orbital component that can be associated with pain, proptosis, motility problems, and vision loss. Like a capillary hemangioma, a lymphangioma is usually present at birth and may enlarge slowly. Intralesional hemorrhage can produce a “chocolate cyst.”
Jakobiec FA, Werdich XQ, Chodosh J, et al. An analysis of conjunctival and periocular venous malformations: clinicopathologic and immunohistochemical features with a comparison of racemose and cirsoid lesions. Surv Ophthalmol. 2014;59(2):236–244.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.