Treatment of Benign Lymphoid Hyperplasia of the Orbit With Rituximab

Orbital reactive lymphoid hyperplasia: Case series and literature review

This study aimed to describe a case series of patients diagnosed with orbital reactive lymphoid hyperplasia (RLH) at a single tertiary care centre. A retrospective review was conducted by searching electronic medical records at Liverpool University NHS Foundation Trust (LUHFT) from 1st December 2021 - 1st December 2023, to identify all patients with a histological diagnosis. Ten patients with an orbital histological diagnosis of RLH were identified. Median age at diagnosis was 56.5 years. Proptosis was the most prevalent presenting symptom, while other signs included palpable mass, ptosis, and diplopia. Eight patients were treated with oral prednisolone, with 20% (two) achieving complete remission. Additional treatments utilised in these cases encompassed doxycycline, mycophenolate, ciclosporin, and azathioprine.This case series represents one of the few reports focusing exclusively on orbital RLH. Notably, bone erosion was observed in this study, a finding that has been scarcely linked to RLH in the literature.

Benign Reactive Lymphoid Hyperplasia of the Conjunctiva Treated With Cyclosporine

PURPOSE

To describe a case of reactive lymphoid hyperplasia (RLH) of the conjunctiva responding to cyclosporine immunosuppressant monotherapy.

METHODS

A 66-year-old man with a 2-year history of biopsy-proven bilateral RLH presented for dry eye evaluation with chief complaints of burning, stinging, and irritation in both eyes. After slit-lamp examination and positive findings of matrix metalloproteinase 9 in the patient's tear film, he was diagnosed with meibomian gland dysfunction and tear-insufficiency dry eye disease. The patient was subsequently treated with topical cyclosporine (ophthalmic emulsion 0.5 mg/mL two times per day) in both eyes.

RESULTS

Examination at the 3-month follow-up visit revealed significant reduction of the RLH lesions bilaterally.

CONCLUSIONS

This report represents the first case of benign ocular RLH responsive to topical cyclosporine therapy. We believe that cyclosporine could play a role in treating patients with benign ocular RLH and warrants further investigation to evaluate its full efficacy.

Topical steroids eye drops in conjunctival reactive lymphoid hyperplasia: Case report

RATIONALE

Conjunctival lymphoproliferative lesions constitute a significant diagnostic challenge and it is essential to exclude neoplastic lesions. Histopathological and immunohistochemical tests are very useful in establishing the correct diagnosis. Reactive lymphoid hyperplasia (RLH) is part of a spectrum of lymphocytic infiltrative disorders. Evidence is scarce regarding appropriate treatment of conjunctival RLH. We report a case treated with topical corticosteroid.

PATIENT CONCERNS

A 40 year-old female presented with a 7-month history of a slow growth tumor in the superior conjunctiva of the right eye. Slit-lamp examination demonstrated salmon colored lesion in the upper conjunctiva, with little conjunctival injection, but no significant neovascularization. There was no eyelid involvement.

DIAGNOSES

Ultrasound biomicroscopy showed lesion depth (1.53 mm) and larger diameter (10.73 mm). Pathological examination revealed a chronic inflammatory process with conjunctival folicular hyperplasia. The immunohistochemistry examination showed predominance of CD20, CD23, and CD 3 e CD 5.

INTERVENTION

We started topic prednisolone 1% 6 times daily.

OUTCOMES

Six months after starting treatment, the lesion completely resolved, without any side-effects or recurrence during three-year follow-up period.

LESSONS

Conjunctival RLH can be managed in various ways, depending on patient symptonm, comorbities, and disease distribution. Surgical resection with cryotherapy, radiotherapy, systemic corticosteroids, subconjunctival triamcinolone, and rituximab are some options. There is no strong evidence in the literature of conjunctival RLH successfully treated with topical eye drops corticosteroid. In this report, we obtained completely resolution of conjunctival RLH with topical corticosteroid.

CONCLUSION

Topical eye drops corticosteroids are an alternative treatment for selected cases of conjuncitval RLH with no orbital or eyelid involvement.

Molecularly targeted agents in oculoplastic surgery

PURPOSE OF REVIEW

Significant advances have been made in oncology and rheumatology with the introduction of molecularly targeted agents (MTAs). MTAs consist of monoclonal antibodies and small molecule inhibitors. The purpose of this manuscript is to review the recent applications of MTAs to orbital, lacrimal, and eyelid disease.

RECENT FINDINGS

The use of monoclonal antibodies has been described in the treatment of orbital vascular lesions, lymphoma, and squamous cell carcinoma. Inflammatory conditions treated with monoclonal antibodies include thyroid eye disease, IgG4 disease, and granulomatosis with polyangiitis. Immunotherapy with checkpoint inhibitors has also found applications to orbital disease. Use of small molecule inhibitors has been described in the treatment of basal cell carcinoma, squamous cell carcinoma, and Erdheim-Chester disease. There are many orbital, lacrimal, and eyelid side effects of MTAs with which the oculoplastic surgeon should be familiar, including hypertrichosis, edema, and orbital and eyelid inflammation.

SUMMARY

MTAs represent the future of treatment of oncologic and inflammatory conditions. Application of these agents to orbital, lacrimal, and eyelid disease will continue to expand. Elucidating the molecular mechanisms of oculoplastic disorders will facilitate additional potential pathways that could be targeted for therapy.