Which clinical history findings are characteristic of orbital and adnexal lymphoma?

Updated: Mar 15, 2019
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Orbital and ocular adnexal lymphoma has an insidious onset and can progress slowly for over a year before producing symptoms. Symptoms are usually secondary to pressure effects on surrounding structures. Clinical features include painless proptosis with or without motility disturbances, double vision, ptosis, and, rarely, decreased vision. The lesions can be unilateral or bilateral. Lymphomatous lesions can involve the preseptal portion of the eyelid.

Orbital lymphomas present with painless proptosis, the lesions being more common in the anterior superior orbit. The mass is usually rubbery to firm on palpation with no palpable bony destruction. The lacrimal gland, lacrimal sac, and extraocular muscles can also be similarly involved.

Orbital lymphoma can also occur in patients with AIDS. [26, 27]

Conjunctival lymphoma has a characteristic salmon-pink appearance (see the image below). It may be an extension of orbital or intraocular lymphoma.

Salmon-pink appearance of conjunctival lymphoma. Salmon-pink appearance of conjunctival lymphoma.

Simultaneous occurrence of intraocular and orbital lymphoma does occur but is rare. [28]

The presence of cervical or preauricular lymphadenopathy, parotid gland swelling, or an abdominal mass can signify systemic disease. Hence, a thorough physical evaluation should be carried out in all patients with ocular lymphoma.


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