The eye in leukemia

In leukemia, any part of the eyeball may be involved in the pathological process. At present, when the mortality rate of these patients has significantly decreased, the terminal stage of leukemia is rare. Pediatric ophthalmologists rarely observe patients with ocular manifestations of leukemia. However, dynamic examinations are necessary due to the likelihood of significant changes in one or both eyes, as well as to identify signs of relapse of the disease and to clarify the effectiveness of the treatment.

Orbit in leukemia

• In myeloid leukemia, bone infiltration known as chloromas may occur.
• In case of relapses of lymphatic leukemia, the orbital tissues may become involved in the process.

Conjunctiva in leukemia

Conjunctival infiltration occurs. Associated hemorrhages are usually associated with conjunctival impregnation, increased blood viscosity, or coagulation disorders.

Cornea and sclera in leukemia

The cornea is rarely involved in the process, except in cases of herpes simplex and herpes zoster when the immune system is compromised.

The lens in leukemia

Cataracts may develop after bone marrow transplantation and subsequent general radiation therapy.

Anterior chamber and iris

Involvement of the iris in the process serves as an indicator of exacerbation of the underlying disease, most often occurring in lymphoblastic leukemia, after interruption of treatment for 2-3 months against the background of remission. Pathology of the iris manifests itself as follows:

• isolated infiltrates;
• sluggish pupillary response;
• heterochromia of the iris;
• objective and subjective signs of iritis;
• hyphema;
• glaucoma.

Diagnosis may require iris biopsy and anterior chamber fluid sampling. Treatment usually involves 3,000 cGy of radiation therapy and topical steroids.

Choroid

In all types of leukemia, the choroid is more often involved in the pathological process than other tissues of the eyeball. Rarely, retinal detachment or subretinal tissue proliferation may occur.

Retina and vitreous changes

1. Increased blood viscosity leads to dilation and tortuosity of the retinal veins, the formation of perivascular cuffs and hemorrhages.
2. Retinal hemorrhages:
   • disruption of the integrity of the vascular wall leads to the occurrence of hemorrhages typical of the leukemic process with a characteristic white focus in the center;
   • subhyaloid hemorrhages;
   • Hemorrhages can be localized in any layer of the retina, including the nerve fiber layer.
3. White spots on the retina:
   • perivascular cuffs;
   • retinal infiltrates, often of hemorrhagic origin;
   • cotton wool lesions that occur after bone marrow transplantation;
   • hard exudate caused by increased permeability of the vascular wall;
   • white lesions, the origin of which is associated with the presence of opportunistic cytomegalovirus or infectious processes in the fundus;
   • focal retinal ischemia with extensive areas of edema.

Optic nerve damage

• Often occurs in the preterminal phase of the disease;
• At earlier stages of the disease it manifests itself less frequently;
• Loss of central vision;
• Prelaminar infiltration is manifested by swelling of the optic disc;
• Retrolaminar infiltration is determined only by scanning methods.

Complications of treatment

Medicines

• Vincristine:
  • optic neuropathy;
  • ptosis;
  • cranial nerve palsy.
• L-asparaginase - encephalopathy;
• Cytarabine - inflammatory processes of the conjunctiva and cornea;
• Methotrexate - arachnoiditis.
• Steroid therapy:
  • cataracts;
  • benign intracranial hypertension.

Immunosuppressant drugs

Infectious processes caused by opportunistic bacteria, viruses, fungi and protozoa, such as herpes zoster or cytomegalovirus.

Complications of bone marrow transplantation for leukemia

1. Cataracts.
2. Trapsitory white spots on the retina.
3. Graft disease:
   • the body does not recognize the recipient's transplant as "its own";
   • dry eye syndrome;
   • cicatricial lagophthalmos;
   • conjunctivitis of non-infectious origin;
   • uveitis;
   • cataracts.

Phakomatosis, a neuroectodermal disorder, is a group of syndromes in which the skin, eye, and central nervous system are involved in a benign process of tissue hyperplasia. This group of diseases includes neurofibromatosis, tuberous sclerosis, Hippel-Lindau disease, and Sturge-Weber syndrome.

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