Secondary Bilateral Orbital Involvement from Primary Non-Hodgkin Lymphoma of the Cheek.

We describe a patient with oculomotor nerve palsy due to secondary orbital infiltration from the primary malignant lymphoma of the cheek. The patient was a 78-year-old female who had non-Hodgkin lymphoma (diffuse large B cell lymphoma [DLBCL]) of the cheek. The patient received chemotherapy and local radiation therapy. The combined treatment brought about complete remission. About 6 months after the last treatment the patient began to have left blepharoptosis and impaired vision. Findings from ophthalmological and neurosurgical examinations suggested no intraorbital or intracranial lesions. Repeated MRI and CT scans also showed no such lesions. One month later, the patient suddenly had a left oculomotor disturbance, diplopia and exophthalmus, followed by right oculomotor nerve palsy. An MRI revealed bilateral intraorbital tumors. Recurrence at the orbital tissue of malignant lymphoma originated from the left cheek appeared to cause the ophthalmological symptoms. Salvage chemotherapy was performed and her ocular symptoms were recovered. However, the patient died approximately 10 months after recurrent orbital tumor onset.