BOX 133 Recommended Staging Workup for Orbital Lymphoma

Thorough history and physical examination Dilated eye examination

Complete blood count and biochemistry profile Liver function tests Chest radiography

Computed tomography or magnetic resonance imaging of orbit Computed tomography of abdomen, thorax, and pelvis

Bone marrow aspiration Open or fine-needle biopsy of orbital mass Upper endoscopy and barium studies Total body positron emission tomography

FIGURE 13.4. Magnetic resonance images in a patient with large-cell lymphoma demonstrate multiple intraorbital masses infiltrating the lacrimal gland and the extraocular muscles. (A) Axial noncon-trast T1-weighted image. (B) Coronal fat-suppressed, contrast-enhanced T1-weighted image.

corneal surface. Despite shielding, tear film insufficiency and subsequent dry eye syndrome frequently occur after radiation therapy for orbital lymphoma. Significant radiation vasculopathy of the retina and optic nerve does not usually occur with the usual total dose used for orbital lymphoma (< 50 Gy).28

Newer approaches in radiation delivery could improve the treatment of orbital tumors in the future. Intensity-modulated conformal therapy, which promises isodose delivery to tumors while sparing the un-involved neighboring structures, may minimize the ocular toxicity due to radiotherapy.29

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