Orbital Lymphoma Masquerading as Orbital Cellulitis

Background. Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands. Orbital malignancies often represent a diagnostic dilemma for clinicians given their varying and atypical presentations. Objective. To report a case of orbital lymphoma mimicking orbital cellulitis. Case. A 66-year-old male patient presented with sudden onset of painful proptosis with visual impairment in the left eye for 15 days. On ocular examination, best-corrected visual acuity was 6/12 in the right eye and 2/60 in the left eye, abaxial proptosis with hypertropia, swollen and erythematous eyelids, restricted extraocular movement in all cardinal position of gaze, conjunctival congestion with chemosis and tortuous vessels, sluggish pupillary reaction, and chorioretinal folds in the inferior quadrants. The case was diagnosed as left eye orbital cellulitis, and the patient was treated with broad-spectrum intravenous antibiotics and oral steroids. No clinically discernible response was noted despite 7 days of antibiotics and steroids. Contrast-enhanced computed tomography (CECT) orbit showed features suggestive of orbital lymphoma involving the ipsilateral maxillary and ethmoid sinuses. ENT consultation with diagnostic nasal endoscopy and biopsy was done. Histopathological reports showed features of non-Hodgkin lymphoma. Conclusion. Orbital malignancies masquerading as orbital cellulitis can pose a diagnostic dilemma. A multidisciplinary approach involving ENT consultation, radiological investigation, and pathological sampling can help achieve a timely diagnosis and appropriate management.

A RARE CASE OF EXTRAOCULAR ORBITAL LYMPHOMA IN A YOUNG PATIENT

Orbital lymphoma refers to a lymphoma that commonly involves the conjunctiva, lacrimal gland, eyelid and ocular musculature. Primary non1 Hodgkin's lymphoma (NHL) of the orbit is a rare subset, representing only 1% of all NHL and 8-10% of extranodal NHL. We report a case of 24 year old female presented with redness, swelling, an intermittent pain and gradual protrusion of the right eye (RE) since 6 months. Her vision in RE was 6/60 and in Left eye (LE) 6/6. Intraocular pressure (IOP) was 16 mmHg in Both Eye. On examination, RE was proptosed 30mm approximately. Extraocular movement were restricted in all gazes, conjunctiva was chemosed and congested. LE was within normal limits. No lymph nodes were palpable. Ultrasonography of the right orbit showed a mass in the lateral aspect in extraconal space extending to the superior, lateral and retrobulbar region. CT scan of the right orbit showed a mass encasing the extraocular muscles and displacement of the optic nerve. FNAC reports were suggestive of non-Hodgkin's Lymphoma of the right orbit. She was given 6 cycles of RCHOP regime which includes (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisolone). Follow-up during each cycle of chemotherapy was done and showed good response initially. Even though rare, primary orbital NHL should be kept in considerat Conclusion- ion in a young female patient with slow growing unilateral Proptosis. After imaging & diagnostic biopsy, patient should be immediately staged & treated. Early diagnosis and treatment improves survival.