Ocular and orbital involvement in leukemia

doi:10.1016/0039-6257(83)90123-6

Survey of Ophthalmology

Volume 27, Issue 4, January–February 1983, Pages 211-232

https://doi.org/10.1016/0039-6257(83)90123-6 Get rights and content

Abstract

Leukemia may involve almost any ocular tissue, by direct infiltration, by hemorrhage, and by ischemic changes. Both acute and chronic leukemia can cause ocular signs, either initially or later in the disease process; the clinical features and pathologic correlations of this involvement are reviewed. Also, various chemotherapeutic agents used to treat leukemia may cause ocular toxicity. Recently, bone marrow transplants have been performed more frequently in an attempt to prolong patient survival; if graft-versus-host disease results, one symptom is dry eyes from alacrima. Superimposed infection due to immunosuppression can occur from the disease itself or from treatment. Recognition by the ophthalmologist of the various ocular signs is important in assessing the course and prognosis of leukemia.

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Leukemia as a neoplastic proliferation of white blood cells was an unknown disease entity until the 19th century. The initial classification by Rudolf Virchow was not meaningfully improved upon until aniline dyes were used for differential staining of white blood cells. The innovation of bone marrow biopsy by either trephination or aspiration provided conceptual insight into how the morphology of white blood cells, red blood cells and platelets was arrested at different stages of development. Ocular involvement by leukemia is usually a sign of advanced, extramedullary disease. Involvement can be through direct leukemic infiltration of ocular or ocular adnexal tissues. Visual function can also be adversely impacted secondarily due to leukemia-related coagulopathies and opportunistic infections. The photograph gallery includes pathology of indirect complications of leukemia on the eye, as well as examples of direct infiltration of the retina, choroid, optic nerve, and orbit.
Bilateral vision loss as initial presentation of chronic myeloid leukemia in a young adult: A case report and review of the literature
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Citation Excerpt :
To date, this is one of only a few reported cases of bilateral blurry vision as the primary presenting symptom of CML in a young adult.6–16 Presenting visual disturbances seen in CML are secondary to choroidal and retinal vascular changes.5 Of the eleven mentioned cases, vitreous hemorrhage, preretinal hemorrhage, optic disc hemorrhage, macular hemorrhage, dot and blot hemorrhage, flame-shaped hemorrhage, Roth spots, intraretinal hemorrhage and subhyaloid hemorrhage have all been documented.6–16
To report a case of bilateral vision loss as the primary presenting symptom of chronic myeloid leukemia in a young adult.
The 28-year-old male patient presented to clinic with visual acuity of 20/200 in both eyes after several months of episodic bilateral vision loss. Intraretinal and pre-retinal hemorrhages were appreciated, as well as Roth spots and peripheral neovascularization. Initial lab findings were consistent with a diagnosis of acute myeloid leukemia, later, upon bone marrow examination, the diagnosis was edited to chronic myeloid leukemia. Dasatinib therapy resulted in a complete hematologic resolution after six weeks. After intravitreal injections of bevacizumab in both eyes, visual acuity improved to 20/25 in the right eye and 20/20 in the left eye.
After review, this is one of only a few reported cases of bilateral blurry vision as the primary presenting symptom of chronic myeloid leukemia in a young adult. Because visual disturbances occur more frequently in acute myeloid leukemia, and lab results may be inconclusive, careful consideration should be given to differentiate myelogenous leukemias, as the acute and chronic subtypes may present similarly.
Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review
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Citation Excerpt :
The ophthalmologist may find signs pointing to CML such as ciliary congestion, anterior uveitis, hypopyon, or neovascularization of the iris.17 Dilated funduscopic examination reveals the presence or absence of vitreous reaction or hemorrhage Roth spots, cotton wool spots, leukemic infiltrates, optic disc (to rule out any edema, hyperemia, neovascularization at the disc, pallor, surrounding hemorrhages or infiltration), the macula (to rule out pre, intra, or subretinal hemorrhages, foveal mottling, retinal pigment epithelial (RPE) changes, infiltrates), the retinal blood vessels (to rule out hemorrhages, sheathing, attenuation, dilatation and tortuosity of vessels, vein occlusion or neovascularization), and any peripheral signs of ischemia.53-57 We should also look for exudative retinal detachment, tractional retinal detachment, or any choroidal pathology.
The presentation of chronic myeloid leukemia (CML) can be variable and related to the phase of the disease. It can manifest a wide range of symptoms and signs; ocular involvement is reported in patients with leukemia at the time of diagnosis. We describe ophthalmic manifestations as an initial presentation in patients with CML. We identified 38 publications between 1971 and 2020 describing ocular manifestations in CML. Ophthalmic problems occur either from direct or indirect infiltration of neoplastic cells or from secondary causes. Although nearly all ocular structures may be affected, leukemic retinopathy is the most frequent clinical manifestation. Others include iris infiltration, anterior uveitis, hypopyon, exudative/serous retinal detachment, and optic nerve infiltration.
Bilateral optic nerve infiltration and leukemic retinopathy as initial signs of leukemia relapse with central nervous system involvement in an adult: A case report
2024, Research Square
Detection of Retinal Microvascular Changes with Optical Coherence Tomography Angiography in Patients with Acute Leukemia Without Retinopathy
2024, Ophthalmology and Therapy

View all citing articles on Scopus

^☆: Supported in part by a Heed Fellowship (Dr. Kincaid) and research grant 1 R01-EY01804, National Eye Institute (Dr. Green).

¹: Dr. Kincaid is currently Assistant Professor of Ophthalmology and Pathology at the University of Texas in San Antonio.

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ReviewOcular and orbital involvement in leukemia☆

Abstract

Exp Eye Res

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthal Surg

Surv Ophthalmol

Br J Ophthalmol

Am J Ophthalmol

Trans Am Acad Ophthalmol Otolaryngol

Int Ophthal Clin

Am J Ophthalmol

Am J Ophthalmol

Lancet

New Engl J Med

Arch Ophthalmol

Am J Ophthalmol

New Zeal Med J

Cancer

Can J Ophthalmol

Arch Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Headaches, vomiting and diplopia in a 16-year-old boy

Clin Pediat

Ocular complications of vincristine therapy

Arch Ophthalmol

Ocular involvement in leukemia and allied disorders

Arch Ophthalmol

Papilledema and ataxia as initial manifestation of acute lymphocytic leukemia

J Ped Ophthalmol

Mumps uveitis complicating the course of acute leukemia

J Ped Ophthalmol

Necrotizing uveitis incident to perfusion of intracranial malignancies with nitrogen mustard or related compounds

Trans Am Ophthalmol Soc

Neurologic complications of acute myelomonoblastic leukemia of four years' duration

Neurology

Changes in the anterior segment as a presenting feature in leukaemia

Br J Ophthalmol

The difficult diagnosis of choroidal melanoma

Arch Ophthalmol

Leukemic optic neuropathy

Int Ophthalmol

Acute lymphocytic leukemia and central serous retinopathy

Trans Am Acad Ophthalmol Otolaryngol

Prolonged cytogenetic and hematologic remission of blastic transformation in chronic granulocytic leukemia

Cancer

Dacryocystitis in acute leukaemia

Br J Ophthalmol

Chloroma-like ocular manifestations in Turkish children with acute myelomonocytic leukaemia

Lancet

Optic nerve head involvement in lymphocytic leukemia

J Ped Ophthalmol

Fundus changes in leukemia

Trans Am Ophthalmol Soc

Anterior segment ischemia: Classification and description in chronic myelogenous leukemia

Ann Ophthalmol

Neurological complications of acute leukemia in adults: Changing rates

Ann Int Med

Optic disc neovascularization associated with ocular involvement in acute lymphocytic leukemia

Retina

Leukemic reticuloendotheliosis with presenting ocular complaints

Arch Ophthalmol

Atypical ocular signs as the initial manifestation of serious systemic diseases

Eye Ear Nose Throat Monthly

Retinal microaneurysms in leukaemia

Br J Ophthalmol

Review
Ocular and orbital involvement in leukemia☆