Radiation Therapy for Tumor-Induced Ptosis Due to Levator Palpebrae Superioris Dysfunction: A Case Report

This report presents a unique case of tumor-induced ptosis caused by follicular lymphoma, successfully treated with radiation therapy (RT). A male in his 70s presented with progressive ptosis, swelling of the right upper eyelid, and difficulty opening the right eye. Imaging revealed a well-defined tumor in the right orbit, causing medial displacement of the globe. Magnetic resonance imaging (MRI) showed the tumor to be mildly hyperintense on T2-weighted imaging (T2WI), and positron emission tomography-computed tomography (PET-CT) demonstrated intense fluorodeoxyglucose (FDG) uptake with a maximum standardized uptake value of 17.5. Histopathological analysis confirmed the diagnosis of follicular lymphoma, predominantly Grade 3B (80%) with a component of diffuse large B-cell lymphoma (DLBCL), not otherwise specified (20%). Staging based on the Lugano classification revealed the disease to be Stage IIE due to bilateral cervical lymphadenopathy. The patient declined systemic chemotherapy and opted for localized RT to the right eyelid tumor. The treatment field excluded lymph node metastases, and RT was delivered to a total dose of 36 Gray in 20 fractions. The treatment was well-tolerated, and no significant adverse effects were observed. Tumor regression was evident, and the patient regained the full ability to open the right eye within one month after the treatment. At the one-year follow-up, the tumor in the right upper eyelid had completely disappeared, and the neck region remained stable. This case highlights the efficacy of RT in treating tumor-induced ptosis caused by dysfunction of the levator palpebrae superioris muscle. Radiation therapy remains a valuable therapeutic option, particularly in scenarios where surgery or chemotherapy is not feasible. Further studies are warranted to validate these findings and develop standardized treatment protocols for this distinct condition.