Images of Memorable Cases: Case 76 This 84-year-old woman presented with a four-month history of painless swelling of all four eyelids (top). On examination, the lids felt boggy, and each eye had pinkish-pale, lobular tissue covering almost the entire bulbar and palpebral conjunctiva (bottom). Generalized lymphadenopathy and mild normocytic, normochromic anemia were additional findings. 76. Conjunctival lymphoma Biopsy of a cervical lymph node showed diffuse, small-cell lymphocytic lymphoma. With conventional chemotherapy, the ocular abnormalities improved substantially, and the generalized adenopathy and anemia resolved. Conjunctival lymphoma usually occurs in persons older than 50 years and affects men and women equally. It can be unilateral or bilateral, with or without systemic involvement. The lesions typically are painless. Definitive diagnosis requires histologic examination and immunohistochemical stains of the involved tissue. Treatment consists of radiotherapy for localized disease and chemotherapy for systemic disease.