Khalid Iqbal Talpur.
Orbito-Blepheral Lymphoma.
Pak J Ophthalmol Jan ;17(4):134-41.

Primary orbital and adnexal lymphomas are Non Hodgkin`s variety and almost exclusively occur in adults with bimodal peaks at 30s & 60`s years of age. A rare case of orbito-blepheral lymphoma in a four years girl is being reported. Review of literature revealed that this is the youngest case of this disease. The route of extension was also unusual. The mass starting from the posterior orbital cavity passed through the narrow space between the eye ball and superior orbital margin and expanded into the upper lid. Excision biopsy was performed followed by chemotherapy. One-year follow-up revealed that the child is free of recurrence. Long term follow-up has been planned.

CASE REPORT: Parents presented a four-year old girl with a mass in the left upper eye lid for the last four months. It was slowly progressive and painless. On examination the mass was firm, round and non-tender. Skin overlying it was mobile and base was fixed with underlying structures. There was complete mechanical ptosis. Ocular examination revealed visual acuity of 6/6. Cornea, anterior chamber, pupil, lens and fundus were normal. Ocular motility was in full range and there was no proptosis. Opposite eye was normal. There was no lymphadenopathy. Liver or spleen were not enlarged. CT Scan showed a dense mass filling the upper lid with some extension into upper orbit. Full blood count and ESR were normal. An excisional biopsy was performed. Mass was isolated from the lid structures and found to be attached at its base with superior orbital margin. On further exploration it was found to be coming from the upper orbital cavity and excised as far as possible deep into the cavity taking care of normal structures. On Histopathological examination the mass was found to be a NonHodgkin`s lymphoma of B-cell type (Fig.3). Later on the child received chemotherapy and has been followed up for one year without any recurrence. A long- term follow-up has been planned.

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