Blurry Vision in a Patient With Leukemia

Abstract

A 57-year-old man with chronic myelogenous leukemia (CML) refractory to multiple tyrosine kinase inhibitors (ie, imatinib, nilotinib, and bosutinib) presented for subacute-onset blurry vision in both eyes. He had been admitted for an upcoming bone marrow transplant. The patient had floaters without flashes and denied any eye pain. A review of symptoms found chronic fatigue and a new, mild headache beginning a few days prior. On examination, his visual acuity was 20/50 OU; intraocular pressures were 15 mm Hg OD and 13 mm Hg OS; and pupils were equal, round, and reactive, without a relative afferent pupillary defect. Extraocular movements, confrontational visual fields, and Ishihara color plates were full. An anterior segment examination had normal results. A fundus examination revealed clinically significant peripapillary intraretinal and preretinal hemorrhages obscuring the optic disc margins of both eyes (Figure 1). A peripheral retinal examination of both eyes had normal results. Diagnosis Terson syndrome in a patient with CML with central nervous system involvement What to Do Next C. Magnetic resonance imaging of the brain and orbits DiscussionThis patient, who had refractory CML and blurry vision, presented with bilateral peripapillary hemorrhages and whitening suggestive of possible optic nerve edema. His presentation was concerning for leuke-