Follicular lymphoma presenting solely as chronic follicular conjunctivitis

Purpose: Conjunctival lymphoma rarely can have atypical clinical presentations. The authors report a case of conjunctival follicular lymphoma that presented solely as bilateral chronic follicular conjunctivitis. This case underscores that the pathological characteristics of conjunctival follicles can only be determined by histopathologic examination. Methods: The patient underwent conjunctival scraping and biopsy after clinical history and examination failed to reveal the etiology of his chronic, symptomatic, follicular conjunctivitis. Results: Histopathologic and immunohistochemical testing disclosed a bilateral low-grade conjunctival follicular lymphoma. The patient was treated with radiation therapy and remained in remission clinically 6 months after the treatment. Conclusions: Although rare, conjunctival lymphoma should be included in the differential diagnosis of chronic follicular conjunctivitis. This case is unique and further supports the notion that tissue biopsy may be needed for chronic, symptomatic conjunctivitis of unknown etiology.