Topical steroids eye drops in conjunctival reactive lymphoid hyperplasia

Abstract

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.

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

“…Literature review revealed 235 reported cases of BRLH in 36 published studies, which are presented in Table 1 [1, 2, 4–12, 14–38]. The mean age at diagnosis of all reported cases was 35.2 years (range, 5 to 91 years), 54% of the patients whose gender was reported were male (100/186), and 46% were female (86/186).…”

“…(Table 1) Fifty-two of these 96 patients (54.1%) underwent excisional biopsy of the BRLH lesions; two of them had residual lesions, which were observed [5, 25], and two received a post-operative course of oral corticosteroids, which failed to eradicate the lesions [5, 19]. Nine patients (9/96 or 9.3%) were treated with topical corticosteroids; only one patient showed a complete response [14] while the rest of the patients experienced a partial response [2, 6, 15]. Two patients treated with topical antihistamines and one patient treated with a topical antibiotic ointment also had a partial response and their lesions were subsequently excised [6].…”

“…Due to the clinical resemblance of BRLH to conjunctival lymphoma and the potential risk of malignant transformation, thorough examination and assessment of such lesions is warranted [1–4, 8, 9, 12, 13]. Various modalities have been used in the treatment of BRLH lesions such as surgical excision, topical, intralesional and/or oral corticosteroids, topical cyclosporine, topical interferon α2b, radiotherapy and observation [1, 2, 4–12, 14–38]. However, there is no established treatment protocol or consensus among experts as to how to manage BRLH lesions.…”