Ophthalmic Manifestations of Haematological Disorders

Abstract

Five case histories are presented. Waldenstrom's macroglobulinaemia caused bilateral central retinal vein occlusion, proptosis was the presenting feature of retro-orbital plasmacytoma in relapsed multiple myeloma, a red painful eye was due to neovascular glaucoma in primary polycythaemia, bilateral VI th nerve palsy caused convergent squint and diplopia in meningeal relapse of acute lymphoblastic leukaemia and lymphoma of the eyelid caused complete ptosis. Interdisciplinary management is described. Ophthalmological lesions in haematological disease should be promptly recognized and managed. Collaboration between ophthalmology and haematology departments may be effective for palliative management.

Concomitant multiple myeloma spectrum diagnosis in a central retinal vein occlusion: a case report and review

“…In regards to ocular risks and treatments, multiple myeloma can cause: proptosis, diplopia, lid ecchymosis, xanthamatosis, conjunctival and corneal deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vein occlusions, retinal microaneurysms, retinal vasculitis, sensory retina detachments, retinal pigmented epithelial detachments and other neuro‐ophthalmic manifestations . Hyperviscosity syndromes, which can be caused by multiple myeloma, have been shown to cause bilateral central retinal vein occlusions (CRVO) in young patients . Therefore, CRVOs in young patients and in patients with bilateral vein occlusions should be thoroughly investigated via laboratory work to rule out an underlying systemic cause, including multiple myeloma …”

“…5,[12][13][14][15][16]18 Hyperviscosity syndromes, which can be caused by multiple myeloma, have been shown to cause bilateral central retinal vein occlusions (CRVO) in young patients. [12][13][14][15][16]24 Therefore, CRVOs in young patients and in patients with bilateral vein occlusions should be thoroughly investigated via laboratory work to rule out an underlying systemic cause, including multiple myeloma. [12][13][14][15][16] Diabetes mellitus and multiple myeloma can overlap in about 11 to 22 per cent of patients.…”

Ocular Manifestations in Patients with Philadelphia-Negative Myeloproliferative Neoplasms

“…Therefore, the manifestations seen in these patients are more often related to anaemia associated with ischemic retinopathy, neovascularisation, retinal haemorrhages and cotton wool spots [17]. Direct involvement of the eyes in the form of extramedullary haematopoiesis is also seen in PMF, similar to different leukaemias [18][19][20][21][22].…”

“…One case of inflammation of the iris, iritis, in an ET patient has been documented [33], and one case of paraneoplastic infiltration of the uveal tract in both eyes resulting in narrow angle-closure glaucoma described [20]. Glaucoma, where the intraocular pressure is high, causing possible damage to the optic nerve, has been reported several times as a cause of underlying MPN disease in all three types of MPNs, and some of the cases where due to neovascular glaucoma secondary to occlusion of the retinal vessels [19,20,34,35].…”

“…The appearance of the fundus in especially untreated or newly diagnosed MPN patients is venous dilation and tortuosity, haemorrhages, cotton wool spots and occasionally Roth spots. These changes often disappear after treatment [14,16,18,19,28,31,[33][34][35][36][37][38][39][40][41][42][43], but most of the literature on the subject consists of case stories. A study by Carraro et al investigated retinopathy and associated fundus lesions in haematological disorders with anaemia and thrombocytopenia [18].…”