Subconjunctival Swelling: Prolapse of Orbital Fat
The present case has been reported in NEJM.

A 59-year-old nonobese man presented with a 7-year history of gradually progressive swelling over the left eye. He had no other clinically significant medical history or history of trauma. There was a soft, yellowish mass in the outer temporal subconjunctival region (Panel A). The patient's vision was normal. Among the disorders in the differential diagnosis, orbital lymphoma was a particular concern.

Characteristic features of an orbital lymphoma typically include a lesion of salmon color that is firm on palpation, that has a solid appearance on computed tomography (CT), and that follows the contour of the orbit without bony erosion. The mass was reducible on direct pressure, and it enlarged on retropulsion of the globe (Panel B), suggesting the fluid nature of its content and intraorbital extension.

CT revealed a density identical to that of intraorbital fat, confirming the clinical impression of subconjunctival prolapse of orbital fat — a benign entity. Surgical intervention may be needed if such a lesion is cosmetically unacceptable or causes discomfort. Clinical recognition of this condition can spare the patient an extensive lymphoma workup, a biopsy, and further follow-up.

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