Intraocular Lymphoma: When to Suspect a Sinister Cause of Ocular Haemorrhage

Abstract

Intraocular lymphoma (IOL) is a rare and life-threatening condition whose aetiology is unclear. Blurred vision, reduced vision, and floaters are common initial symptoms. Posterior vitreous detachment and haemorrhage rarely occur. The authors present the case of a 79-year-old man who initially presented with a 3-month history of fever, night sweats, significant weight loss, bilateral peri-orbital haematoma, red eyes and retro-orbital headache. Physical examination revealed fever, bilateral peri-orbital haematoma, subconjunctival haemorrhage and palpable cervical lymphadenopathy. CT scans detected conical intra-orbital lesions, cervical adenomegalies, expansive lesions in the adrenal glands, and thrombosis of the splenomesenteric confluent and posterior segment of the right branch of the portal vein. These findings were suggestive of a lymphoproliferative disorder. Aspiration cytology of the adrenal mass and inguinal adenopathies was compatible with diffuse large B-cell lymphoma with areas of transformation to Burkitt's lymphoma. We describe a rare form of lymphoma, and a very unusual presentation of primary intraocular lymphoma with atypical symptoms.

Learning points: Intraocular lymphoma is a rare disease and can mimic common infectious or non-infectious uveitis.Bleeding or periocular haematoma are suggestive of intraocular lymphoma.

Keywords: Intraocular lymphoma; adrenal mass; ocular haemorrhage.

Figure 1

Full body CT scan showing cervical adenomegalies, expansive lesions in the adrenal glands, and thrombosis of the splenomesenteric arterynconfluent and posterior segment of the right branch of the portal vein

Figure 2

PET scan demonstrating metabolically active disease at the bilateral intra-orbital, ganglionic, hepatic and bilateral adrenal levels