Bilateral upper and lower lid fatty herniation: an unusual presentation of non-Hodgkin's lymphoma

We report the case of a patient presenting with eyelid hernias who required bilateral upper and lower blepharoplasty; histological examination of the excised fat revealed B-cell non-Hodgkin's lymphoma. At diagnosis, the disease was already systemically advanced, but the patient was asymptomatic. No sign of disease had been detected in the preoperative tests. The bilateral orbital presentation of a systemic lymphoma is very rare, and is usually accompanied and revealed by exophthalmos, increased tear secretion, diplopia and decreased visual acuity. To our knowledge, this is the first case in which lid hernias were the first and only clinical sign of such a systemic disease.