Ophthalmic manifestations of acute leukaemias: the ophthalmologist's role

Abstract

With evolving diagnostic and therapeutic advances, the survival of patients with acute leukaemia has considerably improved. This has led to an increase in the variability of ocular presentations in the form of side effects of the treatment and the ways leukaemic relapses are being first identified as an ocular presentation. Leukaemia may involve many ocular tissues either by direct infiltration, haemorrhage, ischaemia, or toxicity due to various chemotherapeutic agents. Ocular involvement may also be seen in graft-versushost reaction in patients undergoing allogeneic bone marrow transplantation, or simply as increased susceptibility to infections as a result of immunosuppression that these patients undergo. This can range from simple bacterial conjunctivitis to an endophthalmitis. Leukaemia can present as pathology in the adnexae, conjunctiva, sclera, cornea, anterior chamber, iris, lens, vitreous, retina, choroid, and optic nerve. Recognition of the varied ocular presentations is also important in assessing the course and prognosis of leukaemia. We have presented a systematic approach taking each part of the eye in turn and outlining how leukaemia has been shown to affect it.

Ophthalmological Manifestations in Acute Lymphoblastic Leukemia

“…It is usually asymptomatic and can be an autopsy finding (Sharma et al, 2004; www.intechopen.com Burton et al, 2005). Sometimes, a slceral infiltration can simulate a scleritis.…”

“…Sometimes the affectation of the optic nerve is asymptomatic and only papilloedema can be found. (Ribera & Ortega, 2003;Lin et al, 2004;Sharma et al, 2004;Mayo et al, 2002) Papilloedema is the most frequent sign of optic nerve involvement. It can be due to direct infiltration of the nerve by leukemic cells, increased intraocular person, or swelling because of retrolaminar leukemic invasion.…”

“…All kinds of leukemia can affect the orbit, but it is more common in acute lymphoblastic leukemias. (Cardone et al, 2006;Sharma et al, 2004) The symptoms are not different from those caused by other orbital masses, so the diagnosis is usually made after a biopsy of the mass and anatomopathological study. (Abdelouahed et al, 2005).…”

“…A lot of lesions are asymptomatic and the patient is diagnosed in a routine examination by an ophthalmologist. (Ribera & Ortega, 2003;Sharma et al, 2004;Ribera 2006) Therefore, it is important to consider an ophthalmic evaluation at the time of diagnosis of acute leukemia in adults and children. The treatment of the ocular manifestations is complicated, as the penetration of the chemotherapic drugs to the eye is quite difficult, even when they are injected intrathecally.…”

“…Likewise, opportunistic infections due to immunosuppression -particularly viral, protozoal and fungal infections-and the leukemia treatment itself may secondarily involve the ocular system (Rosenthal, 1983;Wu et al, 2006), as well as graft-versus-host reaction or toxicity of the chemotherapy or radiotherapy. (Sharma et al, 2004;Rosenthal, 1983).…”