Lymphoma

Lymphoma is a type of cancer that starts in lymphocytes, which are white blood cells essential to the immune system. It is considered a blood cancer and specifically affects the lymphatic system, a key part of the body's immune defense.

There are two main categories of lymphoma:

• Hodgkin lymphoma (HL): Identified by the presence of Reed-Sternberg cells. It's less common and often considered one of the more treatable forms of cancer.

• Non-Hodgkin lymphoma (NHL): Encompasses a large group of lymphomas without Reed-Sternberg cells. NHL is far more common, accounting for roughly 90% of cases, and includes several subtypes that behave and respond to treatment differently.

Symptoms typically include:

• Painless swelling of lymph nodes (in the neck, armpit, or groin)

• Fever

• Night sweats

• Unintended weight loss

• Itching

• Persistent fatigue

Risk factors can include immune system deficiencies (from conditions such as HIV/AIDS or medications after organ transplant), infections (notably Epstein-Barr virus), family history, autoimmune diseases, and certain environmental exposures.

Diagnosis usually involves a biopsy of an enlarged lymph node, with further tests—such as blood tests and medical imaging—to determine the type and extent (staging) of the disease.

Treatment depends on type and stage but may involve chemotherapy, radiation therapy, targeted therapy, immunotherapy, and sometimes stem cell transplantation. Some forms, particularly slow-growing indolent lymphomas, may be managed with watchful waiting.

Outcomes vary by subtype, with some lymphomas being highly curable and others managed as chronic conditions. In the United States, the five-year survival rate is about 85% for Hodgkin lymphoma and 69% for non-Hodgkin lymphoma.

Ocular manifestations of lymphoma vary based on the type and location within the eye, but common symptoms include:

• Blurred vision or vision loss that does not improve with corrective lenses.

• Floaters (spots, lines, or shapes that drift across vision).

• Redness, swelling, or persistent eye discomfort.

• Foreign body sensation in the eye.

• Increased sensitivity to light (photophobia).

• Eye pain (less common; usually mild if present).

• Bulging of the eyeball (proptosis), more commonly seen with orbital lymphoma (lymphoma around the eye but not within it).

• Flashing lights or a worsening blurry haze.

• Anterior uveitis, vitritis, or macular edema has also been reported as rarer presentations, particularly with some Hodgkin’s lymphoma cases.

Ocular lymphoma can mimic other more common eye conditions such as chronic uveitis, and often the changes are subtle and progress over time. Diagnosis typically requires expert examination and biopsy if lymphoma is suspected.

Lymphoma is the most common blood cancer in many countries and ranks among the top ten cancers worldwide.

Author

Paddy Kalish OD, JD and B.Arch Author and Blogger