A Case of Compressive Optic Neuropathy Secondary to Lymphoma of the Extraocular Muscles

Bilateral enlargement of all extraocular muscles: a presenting ophthalmic sign of hematologic malignancy

Hematologic malignancies such as leukemia and lymphoma can frequently present in the orbit; however, involvement of the extraocular muscles is rare. The authors report two cases of systemic hematologic malignancy presenting with bilateral extraocular muscle enlargement and associated compressive optic neuropathy (CON). Both patients experienced clinical and radiographic improvement of ocular and systemic manifestations of disease with prompt initiation of targeted chemotherapy. These cases highlight the importance of including hematologic malignancy in the differential diagnosis of atypical bilateral extraocular muscle enlargement.

Isolated lateral rectus muscle large B cell lymphoma: A rare case report and review of the literature

Purpose

To report a 65-year-old male patient with primary lateral rectus large B cell lymphoma.

Observations

The patient had been referred because of progressive proptosis and limitation of ductions, especially abduction (ortho position at primary gaze) and conjunctival injection. Computerized tomography of the orbit and paranasal sinuses depicted a massive lateral rectus muscle enlargement without any other orbital involvement. Lateral orbitotomy and lateral rectus belly incisional biopsy was done, and histopathologic and immunohistochemical staining and systemic evaluations revealed the diagnosis of primary orbital large B-cell lymphoma.

Conclusions and importance

This case indicated that, though rare, extraocular muscle enlargement could be the main finding of primary orbital lymphoma. Large B-cell lymphoma could involve only the orbital tissues, although it is more prevalent with systemic involvement.