The extent of systemic evaluation appropriate at the time of diagnosis is uncertain, but, in addition to a careful physical examination with attention to local lymphadenopathy, it might include a complete blood cell count, serum protein electrophoresis, erythrocyte sedimentation rate, and chest and abdominal radiological imaging.6 While it is accepted that patients with ocular adnexal lymphoid lesions should undergo repeated ocular and systemic evaluations to identify extraocular disease, the frequency and extent of such systemic evaluation are also debated. In a review of a series of patients with lymphoid proliferation of the orbit, conjunctiva, and eyelids, Knowles et al3 have reported that approximately 10% of patients of unspecified age followed up for 36 months or longer who presented with clinical stage I disease developed extraocular lymphoma between age 38 and 53 months. Therefore, the authors have recommended repeated systemic evaluation every 6 months for 5 years. However, with the notable exception of reactive lymphoid hyperplasia associated with chronic Epstein-Barr virus infection, reactive lymphoid hyperplasia in childhood is not expected to produce a lymphoma. Therefore, no consensus exists regarding guidelines specific to benign, localized conjunctival lesions in children that might be expected to have an extremely low probability of malignant transformation and extraocular extension.