Extramedullary recurrence of acute lymphoblastic leukemia with initial presentation as a conjunctival mass

A 32-year-old man presented with a 1-month history of redness, blurred vision, and discharge in his right eye. His medical history was remarkable for T-cell acute lymphoblastic leukemia (ALL), and he was in complete remission and on immunosuppression at the time of presentation. Physical exam revealed dilated vessels, conjunctival mass, and diffuse injection in the superonasal quadrant with no other abnormal findings. The patient was started on topical steroids, which showed no improvement. Incisional biopsy was performed, revealing recurrence of ALL. Subsequent imaging unveiled bilateral orbital masses. He was treated with palliative radiation, which resulted in complete response without ocular side effects.