Make your diagnosis in the comments, and look for the answer in next month’s Blink.
Last Month’s Blink
Written by Jaime Badilla, MD, and Sylvia H. Chen, MDCM, MBA, FRCSC, University of Alberta, Edmonton, Alberta, Canada. Photos courtesy of Royal Alexandra Hospital Eye Clinic, Edmonton, Alberta, Canada.
A 68-year-old man presented with a two-month history of mild visual blurring and watery discharge from his right eye.
On slit-lamp exam, a large, homogeneous, salmon-colored conjunctival mass (Fig. 1) was noted with enlarged feeder vessels (Fig. 2); these findings raised suspicion of conjunctival lymphoma. He displayed right globe ptosis (5 mm) and proptosis (6 mm)—an external appearance typical of a slowly enlarging mass—without pain or diplopia. Visual acuity was 20/30 in the right eye, and pupillary reactions and color vision were normal.
Computed tomography showed a conforming, homogeneous, soft tissue mass extending from the superior rectus laterally to the lacrimal region and posteriorly behind the orbit to the optic nerve sheath without bony erosion.
Biopsy confirmed the presence of B-cell lymphoma. The patient was referred to a cancer institute for treatment, where a full assessment revealed no involvement beyond the orbit and optic nerve sheath. The suggested treatment was a total dose of 24 Gy external beam radiotherapy, divided in 12 consecutive doses, for stage IAE marginal zone non-Hodgkin lymphoma of the right eye.1,2
1 Dhakal B et al. Clin Lymphoma Myeloma Leuk. 2017;17(5):305-311.
2 Kirkegaard MM et al. JAMA Ophthalmol. 2016;134(4):406-414.
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