Salmon color sub-epithelial infiltration
Salmon color sub-epithelial infiltration. AS-OCT: Subepithelial hypo reflective infiltrative lesion.

June 2023

OPHTHALMOLOGY

CASE REPORT: EXTRANODAL MARGINAL ZONE LYMPHOMA OF THE OCULAR ADNEXA

By: R. Chris Bowen, MD
A 54-year-old man presented to Northwestern Medicine Ophthalmology with right eye pain and blurred vision. A clinical exam revealed intraocular pressure (IOP) of 35 mmHg in the right eye and 11 mmHg in the left eye, and a salmon colored sub-epithelial conjunctival infiltration and a diffusely shallow anterior chamber in the right eye, and a normal anterior segment in the left eye.

​​Ocular ultrasonography showed massive orbital as well was choroidal infiltration extending into the ciliary body. A biopsy of the lesion confirmed extranodal marginal zone lymphoma (MALT lymphoma).  Systemic evaluation with PET/CT while body imaging and MRI of the brain/orbit showed only right eye/orbit involvement. Our expert radiation oncologist treated the patient with radiation therapy of the right orbit with 24 Gy in 12 fractions. They based their treatment selection on published data showing a local control rate of 96%. Additionally, this low dose is typically well tolerated by patients. 
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These physicians collaborated in the diagnosis and treatment of this patient:  
The patient’s sight-threatening angle closure and massive uveal infiltration has resolved. Three months later, his vision is 20/25 and he is very happy.
 
This case illustrates the strength of our multidisciplinary approach in managing the most complex ophthalmology cases.

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