Ocular Manifestations of Leukemias

Leukemias can involve the eye through direct infiltration of malignant haematopoietic cells or indirectly via secondary effects such as anaemia, thrombocytopaenia and hyperviscosity. Ocular presentations range from asymptomatic fundus changes to sight-threatening complications. The posterior segment is most frequently affected, with retinal haemorrhages, cotton-wool spots and subhyaloid bleeding. Anterior segment findings may include iris infiltration and secondary glaucoma. Orbital masses or proptosis arise when extramedullary collections of blasts localise in the periocular tissues. Optic nerve involvement can manifest as papilloedema or acute vision loss, reflecting the eye’s role as an immunoprivileged sanctuary. Early recognition by ophthalmic examination can expedite diagnosis of systemic disease, guide targeted local therapy and monitor for relapse. Advances in imaging, combined systemic and intravitreal treatments, have improved visual and systemic outcomes, yet challenges remain in delivering adequate drug concentrations across the blood-ocular barrier.

Research from Nature Portfolio

Recent investigations have demonstrated that intravitreal injections of methotrexate markedly reduce intraocular tumour cell infiltration and accompanying inflammation in eyes affected by leukemic deposits. A pioneering retrospective cohort study revealed consistent anatomical resolution and visual stability in treated eyes, underscoring intravitreal methotrexate as a viable adjunct to systemic chemotherapy. These findings highlight the importance of combining local and systemic approaches to overcome pharmacological sanctuaries and achieve durable control of ocular disease.

Ocular Manifestations of Leukemias publication trend

The graph below shows the total number of articles in ocular manifestations of leukemias across all publications each year (not limited to Nature Index journals).

Technical terms

Intravitreal methotrexate: Chemotherapeutic agent delivered directly into the vitreous humour to target intraocular malignancy.

Retinal haemorrhage: Bleeding within one of the layers of the retina, often visible on fundus examination.

Optic nerve infiltration: Invasion of the optic nerve by malignant cells, which can lead to visual loss and disc swelling.

Subhyaloid haemorrhage: Accumulation of blood between the retina and the posterior hyaloid face of the vitreous.

Immunoprivileged site: Body compartment, such as the eye, where immune responses are limited, allowing malignant cells to evade systemic therapy.

References

1. Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate. Scientific Reports (2020).
2. Ophthalmic Manifestations in Acute Leukemia Patients and Their Relation With Hematological Parameters in a Tertiary Care Center. Cureus (2021).
3. Acute Leukemia Presenting in the Pediatric Orbit. Cureus (2022).