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To explore differences in clinical presentations and outcomes between patients with biopsy-proven orbital lymphoma and orbital inflammatory disease. Clinical records of all patients who underwent orbital biopsy at Bristol Eye Hospital during a 10-year period were reviewed. Comparisons were made between patients diagnosed with orbital lymphoma and orbital inflammatory disease (OID). 35 patients were diagnosed with orbital lymphoma, undergoing 40 biopsies over the 10-year period studied. 62 patients had OID, undergoing 66 biopsies. Sub-analysis identified six patients with sarcoidosis, four with granulomatosis polyangiitis (GPA), eight with IgG4-related orbital disease, and 44 with idiopathic orbital inflammation (IOI). Patients with sarcoidosis and IOI were statistically younger at presentation than those with lymphoma, with means of 44 and 52 years, respectively, compared with 71 years. Lid swelling/puffiness was more common in OID than lymphoma. More patients with lymphoma lost vision during follow-up than those with OID. Although younger age of presentation and presence of lid swelling are more likely to indicate orbital inflammation than orbital lymphoma, orbital biopsy remains the gold standard to distinguish these two entities. In the case of orbital inflammation, identification of a specific diagnosis allows appropriate ongoing referral and investigations for potential systemic involvement and helps guide immunosuppressive treatment.

Lymphoma and inflammatory disorders presenting in the orbit– a comparison of characteristics from a 10-year series in a tertiary hospital