Eye in Leukemia

With leukemia, any part of the eyeball may be involved in the pathological process. At present, when the mortality of these patients has significantly decreased, the terminal stage of leukemia is rare. Children's ophthalmologists rarely observe patients with ocular manifestations of leukemia. However, examinations in dynamics are necessary in connection with the probability of significant changes in one or both eyes, as well as in order to identify signs of recurrence of the disease and to clarify the effectiveness of the treatment.

Orbit in leukemia

• With myeloid leukemia, bone infiltration, known as chloromas, can be observed.
• With the recurrence of lymphatic leukemia, it is possible to involve the orbits in the process of tissues.

Conjunctiva in case of leukemia

There is infiltration of the conjunctiva. Concomitant hemorrhages are usually associated with impregnation of the conjunctiva, increased blood viscosity, or disorders of the coagulation system.

Cornea and sclera in leukemia

The cornea is rarely involved in the process, except for the cases of attaching simple and herpes zoster in case of impaired immunity.

Lenticular lens

After bone marrow transplantation and subsequent general radiation therapy, cataract development is possible.

Anterior chamber and iris

Involvement in the process of the iris serves as an indicator of the aggravation of the underlying disease that most often occurs with lymphoblastic leukemia, after interruption for 2-3 months of treatment against a background of remission. The pathology of the iris is manifested as follows:

• isolated infiltrates;
• Sluggish reaction of the pupil;
• heterochromia of the iris;
• objective and subjective signs of irita;
• hyphema;
• glaucoma.

For diagnosis, iris biopsy and a fence for examining anterior chamber humidity may be required. Treatment usually includes radiation therapy at a dose of 3000 cGy and local application of steroids.

Vascular membrane

With all types of leukemia, a vascular membrane is involved in the pathological process more often than other eyeball tissues. Infrequently, but retinal detachment or subretinal tissue proliferation may occur.

Retinopathy and changes in vitreous

1. The increased viscosity of the blood leads to the expansion and tortuosity of the retinal veins, the formation of perivascular couplings and hemorrhages.
2. Retinal hemorrhages:
   • violation of the integrity of the vessel wall leads to the appearance of typical for leukemia process hemorrhages with a characteristic white hearth in the center;
   • subhyaloid hemorrhages;
   • hemorrhages can be localized in any layer of the retina, including the layer of nerve fibers.
3. White foci on the retina:
   • perivascular couplings;
   • retinal infiltrates, often of hemorrhagic origin;
   • vat-like foci occurring after bone marrow transplantation;
   • solid exudate caused by increased permeability of the vascular wall;
   • white foci, the origin of which is associated with the presence of a conditionally pathogenic cytomegalovirus or infectious processes on the fundus;
   • focal retinal ischemia with extensive edema zones.

Lesion of the optic nerve

• Often occurs in the preterminal phase of the disease;
• At earlier stages of the disease is less common;
• Loss of central vision;
• Prelaminar infiltration is manifested by edema of the optic disc;
• Retro-laminar infiltration is established only by scanning methods.

Complications of treatment

Medications

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

Immunosuppressive drugs

Infectious processes, the causative agents of which are conditionally pathogenic bacteria, viruses, fungi and protozoa, for example herpes zoster or cytomegalovirus.

Complications of bone marrow transplantation in leukemia

1. Cataracts.
2. Trapezitor white foci on the retina.
3. Graft disease:
   • the organism does not recognize the transplant recipient for "its own";
   • dry eye syndrome;
   • cicatric lagophthalmus;
   • conjunctivitis of non-infectious origin;
   • uveitis;
   • cataracts.

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

[1], [2], [3], [4], [5], [6], [7], [8], [9]