Conjunctival Reactive Lymphoid Hyperplasia Treated With Topical Steroids Eye Drops

To describe a case of a patient with a reactive lymphoid hyperplasia mimicking a conjunctival lymphoma treated with topical steroids eye drops for a 4-months period, with lesion resolution and no recurrence for the post treatment period.

Germanes Hospitalàries del Sagrat Cor de Jesus “Hospital Sant Rafael”, Barcelona

An 89-year-old patient was referred for itching red eye of weeks of evolution.

Slit-lamp examination showed a salmon colored lesion in the temporal conjunctiva of her red eye with an intense follicular reaction.

Under the presumed diagnosis of conjunctival lymphoma, biopsy and immunohistochemical study was performed, which demonstrated the presence of reactive conjunctival lymphoid hyperplasia with a predominance of CD20, CD3, CD5, bcl-6 and CD23; KI-67 (proliferation index) was under 1%.

After systemic examination -with negative results-, topical treatment with prednisolone 1% eye drops was started 6 times a day, with lesion improvement after a month; a decrease was began going to 4, 3 and 2 times a day each month until complete resolution 4 months after beginning, when treatment was tapered to a once-a-day regimen until discontinuation a month later, with no recurrence being observed for the follow-up period.

Conjunctival lymphoproliferative lesions often constitute a diagnostic challenge. Histopathological and immunohistochemical tests are mandatory for definitive diagnosis, as disease may progress sistemically.

Even when reactive lymphoid hyperplasia is considered a benign lesion, extension studies to rule-out systemic disease are recommended.

Many therapies have been reported, some of them with the use of steroids (topical, local or systemic).

Treatment with topical steroids eye drops may be effective and is non invasive, and so could be considered as a first choice treatment in selected cases.