Periocular steroids in conjunctival reactive lymphoid hyperplasia, a new approach?

Ahmed, Taha Y.; Agarwal, Pankaj; Roberts, Fiona; Diaper, Charles

doi:10.1111/j.1442-9071.2011.02501.x

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…An additional challenge that BRLH conjunctival lesions pose to the clinician is their potential to develop into conjunctival lymphoma. When compared to BRLH lesions in the orbit, lesions in the conjunctiva have been associated with a lower incidence of transformation to lymphoma [4, 6, 15, 16, 24, 25, 27, 33, 63, 64]. In our review of the literature, only 2 of the 235 reported cases (0.8%) developed malignancy, one localized to the conjunctiva [12] and one systemic [1].…”

Section: Discussionmentioning

confidence: 93%

“…Surgical excision, despite its curative and diagnostic role, is considered by some to be an unnecessary and potentially harmful procedure for a localized and benign disease such as BRLH, especially when concerning pediatric patients [25, 28]. Corticosteroids, despite being an inexpensive solution, are associated with slow regression and poor response especially in residual lesions, with side effects including ocular hypertension and cataract formation [4, 5, 16, 29]. Finally, external beam radiotherapy carries the risk of cataract, dry eye, and rarely, radiation-related retinopathy [5, 27, 29].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

et al. 2019

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Background To report a case of bilateral benign reactive lymphoid hyperplasia (BRLH) of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation, treatment and risk of transformation to lymphoma. Case presentation A case report is described and review of the literature from January 1975 to January 2019 was performed. A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions. Incisional biopsy revealed BRLH. Oral doxycycline was initiated (100 mg two times a day) for a total of 2 months. Both lesions decreased in size significantly at the patient’s two-month follow up visit. The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years. The lesion in the left eye has remained stable in size after cessation of the oral doxycycline. A total of 235 cases of conjunctival BRLH were identified in our literature search. The mean age at diagnosis was 35.2 years (range, 5 to 91 years). BRLH lesions were unilateral in 75% of patients and bilateral in 25% of them. Seven patients (2.9%) had a concurrent Epstein-Barr virus (EBV) infection at the time of lesion appearance. The most common treatments were surgical excision (155/235 or 65.9%) and corticosteroids (30/235 or 12.7%), while 14% (33/235) of the patients were observed and 4.6% (11/235) received external beam radiotherapy alone. Recurrence occurred in ten patients (10/235 or 4.2%), of whom five had undergone surgical excision alone, two excision followed by external beam radiotherapy, one excision and oral corticosteroids, one radiotherapy alone and one had been treated with topical corticosteroids. Overall, only 2 of the 235 reported cases (0.8%) developed malignancy, one localized to the conjunctiva and one systemic. Conclusions Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa. Extensive literature review shows that most cases are treated with surgery, steroids or observation. Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions. BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

et al. 2019

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“…However, new approaches, less invasive, have been emerged. Ahmed et al [ 5 ] reported a case of RLH treated with one subconjunctival triamcinolone injection, with complete regression and no recurrence in three and half years of follow-up. Telander et al [ 11 ] had also similar results using single dose of subconjunctival triamcinolone for benign lymphoid hyperplasia, with complete resolution in two months after injection.…”

Section: Discussionmentioning

confidence: 99%

“…Biological therapies and immune modulators have shown promising results but not without side effects. [ 5 ] We report a case treated with topical corticosteroids. A dramatic response was obtained, which may represent a good therapeutic option.…”

Section: Introductionmentioning

confidence: 99%

Topical steroids eye drops in conjunctival reactive lymphoid hyperplasia

Moraes

Nascimento²,

Neto³

et al. 2017

Medicine

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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.

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“…One patient had no recurrence during 42 months of followup, and the other died from an unrelated cause 9 months after treatment without evidence of disease. 5,6 The most devastating complication of intraorbital corticosteroid injection is retinal artery occlusion caused by embolization of corticosteroid particulates and retrograde arterial flow induced by high injection pressures. 4 Fortunately, this is rare and is primarily associated with injections into capillary hemangiomas.…”

Section: Discussionmentioning

confidence: 99%

Intraorbital corticosteroid injection for orbital reactive lymphoid hyperplasia

Andrew

Kearney

Selva

2013

Eye

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Purpose The purpose of this study is to assess the utility of intraorbital injection of triamcinolone acetonide as a primary treatment option for orbital reactive lymphoid hyperplasia (RLH). Patients and method Retrospective, single-centre, interventional case series. Results Intraorbital injection of triamcinolone acetonide was associated with complete resolution of all symptoms and signs in four cases (80%). This was achieved with a single injection in two cases and with two injections in another two cases. Radiological resolution was confirmed in one case. One case developed bilateral multifocal orbital RLH lesions 1 month after the second injection. Conclusion Intraorbital injection of corticosteroid may be a useful treatment option for orbital RLH, and may have a role as a first-line therapy in RLH of the anterior orbit. A significant proportion of patients may require repeat injections to achieve resolution. A larger prospective study is required to validate our findings.

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Periocular steroids in conjunctival reactive lymphoid hyperplasia, a new approach?

Cited by 5 publications

References 4 publications

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

Topical steroids eye drops in conjunctival reactive lymphoid hyperplasia

Intraorbital corticosteroid injection for orbital reactive lymphoid hyperplasia

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