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Ophthalmologic Manifestations of Leukemias Follow-up

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Apr 02, 2015


See the list below:

  • Ocular complications
    • Posterior segment complications from bone marrow transplants were seen in 13% of patients. Among the complications seen were vitreous hemorrhage, infectious retinitis, cotton-wool spots, and retinal detachment.
    • Radiation retinopathy has been reported to occur in patients undergoing bone marrow transplant and high-dose chemotherapy and who received low-dose teletherapy. High-dose chemotherapy may lower the threshold for radiation retinopathy.
    • Ocular ischemia evidenced by optic disc and retinal neovascularization may lead to tractional retinal detachment following chemotherapy and radiation therapy.
    • Dry eye, keratitis, and cataracts may be sequelae of external beam radiation therapy with 3000-4000 rads. However, as little as 1150 rads may cause lenticular opacities.
    • In one study, 82 ALL survivors and 15 AML survivors were followed for an average of 3 years. All of the AML survivors had a normal ocular examination. Cataracts developed in 52% of ALL survivors. However, only 1 patient suffered significant visual dysfunction as a result of ALL or its treatment.[15]


See the list below:

  • Leukemic retinopathy usually is seen in patients who show a relapse and does not imply a bad prognosis.
  • Leukemic infiltration portends a poor prognosis and usually is associated with CNS involvement.
  • Optic nerve head infiltration is associated with CNS disease and a poor prognosis.
  • Prognosis of ALL is age dependent. Children have a much better outlook than adults. See Mortality/Morbidity.

Patient Education

For patient education resources, see the Cancer Center and Leukemia.

Contributor Information and Disclosures

Lihteh Wu, MD Asociados de Macula Vitreo y Retina de Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering.


Joaquin Martinez, MD, MSc Consulting Staff, Department of Ophthalmology, Hospital Nacional de Ninos and Clinica Dr. Clorito Picado; Director of Retinal and Vitreous Clinic at Hospital Nacional de Ninos; Consulting Staff in Ultrosonography and Angiography, Clinica Oftalmologica Costarricense; Private Practice, San Rafael de Escazu, San Jose, Costa Rica

Joaquin Martinez, MD, MSc is a member of the following medical societies: Costa Rican Ophthalmology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.


Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

  1. Wang L, Lawrence MS, Wan Y, et al. SF3B1 and other novel cancer genes in chronic lymphocytic leukemia. N Engl J Med. 2011 Dec 29. 365(26):2497-506. [Medline].

  2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009 Jul-Aug. 59(4):225-49. [Medline]. [Full Text].

  3. Karesh JW, Goldman EJ, Reck K, Kelman SE, Lee EJ, Schiffer CA. A prospective ophthalmic evaluation of patients with acute myeloid leukemia: correlation of ocular and hematologic findings. J Clin Oncol. 1989 Oct. 7(10):1528-32. [Medline].

  4. Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karp JE, Graham ML. Ophthalmic manifestations of leukemia. Arch Ophthalmol. 1989 May. 107(5):697-700. [Medline].

  5. Kincaid MC, Green WR. Ocular and orbital involvement in leukemia. Surv Ophthalmol. 1983 Jan-Feb. 27(4):211-32. [Medline].

  6. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005 Mar-Apr. 55(2):74-108. [Medline]. [Full Text].

  7. Zimmerman LE, Font RL. Ophthalmologic manifestations of granulocytic sarcoma (myeloid sarcoma or chloroma). The third Pan American Association of Ophthalmology and American Journal of Ophthalmology Lecture. Am J Ophthalmol. 1975 Dec. 80(6):975-90. [Medline].

  8. Radich JP. How I monitor residual disease in chronic myeloid leukemia. Blood. 2009 Oct 15. 114(16):3376-81. [Medline].

  9. Kaufman M, Rubin J, Rai K. Diagnosing and treating chronic lymphocytic leukemia in 2009. Oncology (Williston Park). 2009 Nov 15. 23(12):1030-7. [Medline].

  10. Russo V, Scott IU, Querques G, Stella A, Barone A, Delle Noci N. Orbital and ocular manifestations of acute childhood leukemia: clinical and statistical analysis of 180 patients. Eur J Ophthalmol. 2008 Jul-Aug. 18(4):619-23. [Medline].

  11. Ohanian M, Borthakur G, Quintas-Cardama A, Mathisen M, Cortés JE, Estrov Z. Ocular granulocytic sarcoma: a case report and literature review of ocular extramedullary acute myeloid leukemia. Clin Lymphoma Myeloma Leuk. 2013 Feb. 13(1):93-6. [Medline].

  12. Wu L, Calderon M, Hernandez G, Marbis J, Ramirez V. Bilateral exudative retinal detachment as the first sign of relapsing acute myelogenous leukaemia. Clin Experiment Ophthalmol. 2006 Aug. 34(6):623-5. [Medline].

  13. Kulbacki E, Schneider E, Wang E. Hypopyon' in the anterior chamber: unilateral ocular relapse of acute myeloid leukaemia in a 2-year-old girl. Br J Haematol. 2013 Aug. 162(3):293. [Medline].

  14. Sykakis E, Patwary SN. Acute myeloid leukaemia presenting as gaze palsy. Case Rep Ophthalmol. 2011 Sep. 2(3):343-6. [Medline].

  15. Hoover DL, Smith LE, Turner SJ, Gelber RD, Sallan SE. Ophthalmic evaluation of survivors of acute lymphoblastic leukemia. Ophthalmology. 1988 Feb. 95(2):151-5. [Medline].

  16. Abramson DH, Wachtel A, Watson CW, Jereb B, Wollner N. Leukemic hypopyon. J Pediatr Ophthalmol Strabismus. 1981 May-Jun. 18(3):42-4. [Medline].

  17. Ayliffe W, Foster CS, Marcoux P, Upton M, Finkelstein M, Kuperwaser M, et al. Relapsing acute myeloid leukemia manifesting as hypopyon uveitis. Am J Ophthalmol. 1995 Mar. 119(3):361-4. [Medline].

  18. Baumal CR, Levin AV, Read SE. Cytomegalovirus retinitis in immunosuppressed children. Am J Ophthalmol. 1999 May. 127(5):550-8. [Medline].

  19. Brooks HW, Evans AE, Glass RM, Pang EM. Chloromas of the head and neck in childhood. The initial manifestation of myeloid leukemia in three patients. Arch Otolaryngol. 1974 Oct. 100(4):306-8. [Medline].

  20. Camera A, Piccirillo G, Cennamo G, Tranfa F, Rosa N, Frigeri F, et al. Optic nerve involvement in acute lymphoblastic leukemia. Leuk Lymphoma. 1993 Sep. 11(1-2):153-5. [Medline].

  21. Candoni A, Simeone E, Bandello F, Fanin R. Leukaemic infiltration of the retina at onset of Philadelphia-positive acute lymphoblastic leukaemia revealed by stratus optical coherence tomography. Br J Haematol. 2006 Jun. 133(5):455. [Medline].

  22. Consul BN, Kulshrestha OP, Mehrotra AS. Bilateral proptosis in acute myeloid leukaemia. Br J Ophthalmol. 1967 Jan. 51 (1):65-7.

  23. Cook BE Jr, Bartley GB. Acute lymphoblastic leukemia manifesting in an adult as a conjunctival mass. Am J Ophthalmol. 1997 Jul. 124(1):104-5. [Medline].

  24. Davis JL, Parke DW 2nd, Font RL. Granulocytic sarcoma of the orbit. A clinicopathologic study. Ophthalmology. 1985 Dec. 92(12):1758-62. [Medline].

  25. De Juan E, Green WR, Rice TA, Erozan YS. Optic disc neovascularization associated with ocular involvement in acute lymphocytic leukemia. Retina. 1982. 2(2):61-4. [Medline].

  26. Ells A, Clarke WN, Noel LP. Pseudohypopyon in acute myelogeneous leukemia. J Pediatr Ophthalmol Strabismus. 1995 Mar-Apr. 32(2):123-4. [Medline].

  27. Guyer DR, Schachat AP, Vitale S, Markowitz JA, Braine H, Burke PJ, et al. Leukemic retinopathy. Relationship between fundus lesions and hematologic parameters at diagnosis. Ophthalmology. 1989 Jun. 96(6):860-4. [Medline].

  28. Harnett AN, Plowman PN. The eye in acute leukaemia. 2. The management of solitary anterior chamber relapse. Radiother Oncol. 1987 Nov. 10(3):203-7. [Medline].

  29. Jordan DR, Noel LP, Carpenter BF. Chloroma. Arch Ophthalmol. 1991 May. 109(5):734-5. [Medline].

  30. Kaikov Y. Optic nerve head infiltration in acute leukemia in children: an indication for emergency optic nerve radiation therapy. Med Pediatr Oncol. 1996 Feb. 26(2):101-4. [Medline].

  31. Kerty E, Vigander K, Flage T, Brinch L. Ocular findings in allogeneic stem cell transplantation without total body irradiation. Ophthalmology. 1999 Jul. 106(7):1334-8. [Medline].

  32. Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin. 1999 Jan-Feb. 49(1):8-31, 1. [Medline].

  33. Leonardy NJ, Rupani M, Dent G, Klintworth GK. Analysis of 135 autopsy eyes for ocular involvement in leukemia. Am J Ophthalmol. 1990 Apr 15. 109(4):436-44. [Medline].

  34. Lopez-Jimenez J, Sanchez A, Fernandez CS, Gutierrez C, Herrera P, Odriozola J. Cyclosporine-induced retinal toxic blindness. Bone Marrow Transplant. 1997 Aug. 20(3):243-5. [Medline].

  35. MacLean H, Clarke MP, Strong NP, et al. Primary ocular relapse in acute lymphoblastic leukemia [see comments]. Eye. 1996. 10 (Pt 6):719-22. [Medline].

  36. Mehta AB, Goldman JM, Kohner E. Hyperleucocytic retinopathy in chronic granulocytic leukaemia: the role of intensive leucapheresis. Br J Haematol. 1984 Apr. 56(4):661-7. [Medline].

  37. Ng JS, Lam DS, Li CK, Chik KW, Cheng GP, Yuen PM, et al. Ocular complications of pediatric bone marrow transplantation. Ophthalmology. 1999 Jan. 106(1):160-4. [Medline].

  38. Ohkoshi K, Tsiaras WG. Prognostic importance of ophthalmic manifestations in childhood leukemia. Br J Ophthalmol. 1992 Nov. 76(11):651-5. [Medline].

  39. Pakisch B, Langmann G, Langmann A, Slavc I, Poier E, Urban C, et al. Ocular sequelae of multimodal therapy of hematologic malignancies in children. Med Pediatr Oncol. 1994. 23(4):344-9. [Medline].

  40. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin. 1999 Jan-Feb. 49(1):33-64, 2. [Medline].

  41. Pauleikhoff D, Messmer E, Beelen DW, Foerster M, Wessing A. Bone-marrow transplantation and toxoplasmic retinochoroiditis. Graefes Arch Clin Exp Ophthalmol. 1987. 225(3):239-43. [Medline].

  42. Phillips WB, Shields CL, Shields JA, Eagle RC, Masciulli L, Yarian DL. Nocardia choroidal abscess. Br J Ophthalmol. 1992 Nov. 76(11):694-6. [Medline].

  43. Primack JD, Smith ME, Tychsen L. Retinal detachment in a child as the first sign of leukemic relapse: histopathology, MRI findings, treatment, and tumor-free follow up. J Pediatr Ophthalmol Strabismus. 1995 Jul-Aug. 32(4):253-6. [Medline].

  44. Reddy SC, Jackson N, Menon BS. Ocular involvement in leukemia--a study of 288 cases. Ophthalmologica. 2003 Nov-Dec. 217(6):441-5. [Medline].

  45. Reddy SC, Menon BS. A prospective study of ocular manifestations in childhood acute leukaemia. Acta Ophthalmol Scand. 1998 Dec. 76(6):700-3. [Medline].

  46. Rootman J, Gudauskas G. Treatment of ocular leukemia with local chemotherapy. Cancer Treat Rep. 1985 Jan. 69(1):119-22. [Medline].

  47. Rosenthal AR. Ocular manifestations of leukemia. A review. Ophthalmology. 1983 Aug. 90(8):899-905. [Medline].

  48. Rubinfeld RS, Gootenberg JE, Chavis RM, Zimmerman LE. Early onset acute orbital involvement in childhood acute lymphoblastic leukemia. Ophthalmology. 1988 Jan. 95(1):116-20. [Medline].

  49. Shibasaki H, Hayasaka S, Noda S, Masaki Y, Yamamoto D. Radiotherapy resolves leukemic involvement of the optic nerves. Ann Ophthalmol. 1992 Oct. 24(10):395-7. [Medline].

  50. Suh DW, Ruttum MS, Stuckenschneider BJ, Mieler WF, Kivlin JD. Ocular findings after bone marrow transplantation in a pediatric population. Ophthalmology. 1999 Aug. 106(8):1564-70. [Medline].

  51. Takahashi T, Oda Y, Isayama Y. Leukemic optic neuropathy. Ophthalmologica. 1982. 185(1):37-45. [Medline].

A 4-year-old boy presented with sudden proptosis of his left eye.
Same patient as in the image above. A CBC revealed anemia (Hb 8.6 mg/dL), thrombocytopenia (64,000), and leukocytosis (12,900). The peripheral smear revealed the presence of blasts 28%, lymphocytes 44%, segmented 14%, monocytes 6%, bands 2%, metamyelocytes 1%, and myelocytes 1%. The boy was diagnosed with AML type M4-M5 chloroma of the left orbit.
CT scan reveals infiltration in the left orbit. Notice that the bone is uninvolved. A lumbar puncture revealed that the cerebral spinal fluid was clean of leukemic cells.
Systemic chemotherapy was instituted, and the proptosis resolved. Unfortunately, 4.5 months later, the boy passed away secondary to multiorgan failure.
An impending bilateral central retinal vein obstruction was discovered during a routine examination of a 76-year-old man. Further workup revealed a WBC count of 709,000, a hemoglobin count of 12 mg/dL, and a platelet count of 104,000. The man was eventually diagnosed with CML. This image is a red-free photograph of the right fundus. Notice the intraretinal hemorrhages.
Same patient as in the image above. This image is a red-free photograph of the left eye showing intraretinal hemorrhages.
A 14-year-old boy with a past medical history of ALL complained of a sudden loss of vision OD. Visual acuities were counting fingers OD and 20/20 OS. Notice the macular hemorrhage responsible for the loss of vision. Courtesy of Dr Rafael Jiménez.
Same patient as in the previous image. The hematological workup revealed a hemoglobin count of 5.6, a WBC count of 1800, and a platelet count of 3000. Courtesy of Dr Rafael Jiménez.
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