Ocular adnexal lymphoma presenting as incidental tarsal follicles

PURPOSE: To report a case of ocular adnexal lymphoma presenting as asymptomatic follicles discovered incidentally on routine examination. OBSERVATIONS: A 43-year-old woman presented for routine annual examination and was incidentally found to have unilateral giant follicles in the left eye inferior fornix. She denied any ocular or systemic symptoms. The remainder of the examination was unremarkable, and the patient was otherwise healthy. A conjunctival biopsy revealed a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma. She underwent external beam radiation therapy, resulting in complete resolution of the follicles. CONCLUSIONS AND IMPORTANCE: Awareness of atypical presentations of conjunctival lymphoma and thorough slit lamp examinations, even on routine exams, may help expedite diagnosis and treatment.