弥漫大B细胞淋巴瘤（DLBCL）是成人中最常见的淋巴恶性肿瘤。它是一种侵袭性的肿瘤，需要多学科联合治疗，包括化疗、放疗和免疫疗法。一位63岁的马来男性患者有2型糖尿病、高血压、缺血性心脏病和2期慢性肾脏病的基础疾病。患者出现了双侧眼球突出、眼睑肿胀和红眼等症状1个月，还抱怨右眼视力模糊。检查时，对光反应阴性，并发现双侧眼球突出、结膜水肿和注视受限。右眼还出现了暴露性角膜病变，并伴有升高的眼内压。颈部和腋窝淋巴结触及明显。头颅和眼眶的计算机断层扫描显示双侧眼眶内肿块，未见骨质破坏。对上眼睑进行切口活检后，确诊为多发性骨髓瘤1（MUM-1）阳性的弥漫大B细胞淋巴瘤，定义为激活型B细胞亚型（ABC）。他由血液学家共同治疗，采用了利妥昔单抗-环磷酰胺、多柔西汀、长春新碱、泼尼松（R-CHOP）化疗方案。治疗完成后，双侧眼球突出、结膜水肿和注视受限得到缓解。然而，右眼视力仍然很差，因为患者出现了中央自缝角膜穿孔和虹膜堵塞，已经愈合但形成了瘢痕。弥漫大B细胞眼眶淋巴瘤是一种生长迅速、侵袭性强的肿瘤，因此早期诊断和及时多学科治疗对预后至关重要。 Copyright © 2023, Balasubaramaniam et al.

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults. It is an aggressive malignancy and requires a multidisciplinary approach with various modalities which include chemotherapy, radiotherapy as well as immunotherapy. A 63-year-old Malay male patient with underlying type 2 diabetes mellitus, hypertension, ischemic heart disease, and stage II chronic kidney disease presented with a one-month history of bilateral eye proptosis associated with lid swelling and red eye. He also complained of progressive right eye blurring of vision. Visual acuity was counting fingers on the right and 6/18 on the left. On examination, the relative afferent pupillary defect was negative. There was bilateral eye proptosis, conjunctival chemosis, and restricted extra-ocular movement in all gazes. There was also exposure keratopathy over the right eye, and intraocular pressure was raised. Bilateral cervical and axillary lymph nodes were palpable. A computerized tomography scan of the brain and orbit revealed bilateral orbital masses with no bony erosions. An incisional biopsy over the upper lid confirmed the diagnosis of diffuse large B-cell lymphoma with multiple myeloma-1 (MUM-1) positivity which defines the activated B-cell subtype (ABC). He was co-managed with a hematologist and was commenced on the rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) chemotherapy regime. Bilateral eye proptosis, chemosis, and restriction of extra-ocular movement resolved after the completion of treatment. However, right eye vision remains poor as the patient developed central self-sealed corneal perforation with iris plugging which has healed with scarring. Diffuse large B-cell orbital lymphoma is a fast-growing and aggressive tumor, hence early diagnosis and prompt multi-disciplinary treatment are crucial for a good outcome.Copyright © 2023, Balasubaramaniam et al.