Conjunctival lymphoma
ICD-10 C69.0 ICD-11 2B33.5&XA8PS3

Treatment of Conjunctival Lymphoma Localized to the Conjunctiva

Treatment selection in conjunctival lymphoma depends critically on whether disease is confined to the conjunctiva or has spread beyond it. This protocol addresses the localized scenario — tumor restricted to the conjunctiva without dissemination to other parts of the body.

Clinical scenario
Conjunctival lymphoma localized to the conjunctiva, with no evidence of disseminated disease elsewhere in the body. Individual treatment is determined by whether the tumor is localized to the conjunctiva or disseminated to other parts of the body.
Treatment approach
For disease localized to the conjunctiva, external-beam radiotherapy (EBRT) is the established first-line mainstay. Beyond radiotherapy, several alternative treatment modalities — including intralesional therapies and, in select cases, surgical approaches — may be considered depending on disease characteristics and histologic subtype. The complete regimen, dosing details, sequencing, and full algorithm are available in the structured protocol below.
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References

  1. Individual treatment is determined by whether the tumor is localized to the conjunctiva or disseminated to other parts of the body.
  2. The mainstay of treatment for localized disease is external-beam radiotherapy (EBRT) with 30 to 36 gray (Gy), usually given in 20 daily fractions of 1.8 Gy.
  3. Several cases of complete remission in patients after eight weeks of intralesional injections of interferon alfa-2b have been described in localized conjunctival lymphoma. The drug's role is limited to low-grade lymphomas.
  4. Intralesional injections of the CD20 antibody rituximab, combined with autologous serum, have led to complete remission in several cases of MALT lymphoma and follicular lymphoma.
  5. A recent phase 2 trial using targeted radioimmunotherapy with Zevalin (yittrium-90 ibritumomab tiuxetan) presents a promising first-line therapy for patients with early stage extranodal B-cell lymphoma of the ocular adnexa.
  6. If the conjunctival lesion is relatively small and circumscribed, an excisional biopsy and careful observation might suffice.
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