Lymphomatous optic neuropathy

L. B. Kline, J. H. Garcia and G. R. Harsh 3rd

Optic neuropathy as the first sign of a lymphoreticular neoplasm is rare. A 65-year-old man complained of initially transient and then progressive visual loss in the right eye for two weeks. Computed tomography demonstrated a mass in the region of the intracranial portion of the right optic nerve. Frontal craniotomy was performed and histopathologic examination of the tumor disclosed a granulomatous process. Regrowth of the mass and visual deterioration, despite systemic steroid therapy, prompted surgical reexploration. Histopathologic examination confirmed large cell lymphoma. After local radiotherapy (2,500 rad), the patient is well and free of local or systemic lymphoma one year later. Other reported cases of lymphomatous optic neuropathy are reviewed and the diagnostic difficulties encountered are discussed.