Mucosa-associated lymphoid tissue lymphoma masquerading as herniated orbital fat

Lymphomas are the most common primary orbital malignancies in adults. The authors present a 62-year-old Hispanic woman with a 2-year history of slowly enlarging bilateral lower eyelid masses that the patient described as "bags." On palpation, firm, mobile, nontender masses with associated tear trough deformities were noted. Biopsy of the left lower eyelid mass was consistent with a mucosa-associated lymphoid tissue lymphoma. Herniated orbital fat is an extremely common finding in the aging population and is often associated with a prominent tear trough. The patient with orbital lymphoma appeared to have herniated orbital fat with associated tear trough deformities. Lymphoma resembling herniated orbital fat is uncommon but should be considered in all patients with prominence in the periorbital region.