Purpose

To report a rare case of orbital angiolymphoid hyperplasia with eosinophilia (ALHE) initially mimicking orbital lymphoma and successfully managed with serial intralesional corticosteroid injections followed by reconstructive surgery.

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Methods

A 44-year-old female presented with unilateral orbital inflammation, proptosis, hypoglobus, motility restriction, ptosis, and a superior subconjunctival salmon-colored lesion suspicious for lymphoproliferative disease. PET imaging demonstrated isolated orbital involvement. Histopathology and immunohistochemistry confirmed ALHE with vascular proliferation and eosinophil-rich inflammatory infiltrate. Between November 2024 and January 2026, six serial subconjunctival and retrobulbar triamcinolone injections were administered under sedation.

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Results

Progressive clinical and radiologic regression was observed with marked improvement in proptosis, inflammation, and motility. Residual restrictive hypotropia, ptosis, and lower lid fat prolapse persisted despite tumor regression. Following stabilization, reconstructive surgery was performed including inferior rectus hangback recession, posterior ptosis repair, and transconjunctival lower blepharoplasty with CO₂ laser-assisted lipectomy. Final outcome demonstrated excellent functional and aesthetic rehabilitation.

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Conclusion

Orbital ALHE may mimic lymphoproliferative disease and requires histopathologic confirmation. Serial intralesional corticosteroid therapy achieved substantial regression and avoided aggressive orbital surgery during the active phase. Residual sequelae were successfully managed with staged reconstructive rehabilitation.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mariam	Davitashvili	Vissum Grupo Miranza Alicante

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