Letter to the Editor: Comment on Yu X, et al's "Conjunctival Atypical Lymphoid Hyperplasia Associated with Cytomegalovirus Infection: A Case Report".

We comment on the report of bilateral conjunctival atypical lymphoid hyperplasia with cytomegalovirus (CMV) positivity by Yu et al. While the case is clinically valuable, we believe that the available findings do not establish active CMV infection or a causal relationship with lymphoid hyperplasia. We discuss the lack of tissue CMV PCR, discordant immunoglobulin heavy-chain clonality between eyes, diagnostic overlap with ocular adnexal lymphoma, and the need to consider lacrimal gland involvement and IgG4-related disease. We encourage cautious interpretation and longer clinicopathological follow-up.