Journal of Ophthalmic and Vision Research

ISSN: 2008-322X

The latest research in clinical ophthalmology and the science of vision.

Unilateral Blurred Vision as the Sole Presenting Symptom of Chronic Lymphocytic Leukemia

Published date: Feb 03 2020

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: January–March 2020, Volume 15, Issue 1

Pages: 109–112

DOI: 10.18502/jovr.v15i1.5958

Authors:

Rajesh K. Sharmarsharma@umc.eduDepartment of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA; Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA

Kevin MaysDepartment of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA

Abstract:

Purpose: To describe a case of infiltrative optic neuropathy caused by chronic lymphocytic leukemia.

Case Report: A 41-year-old white male presented with painless, blurry vision in the left eye. Examination revealed unilateral optic nerve swelling confirmed by optical coherence tomography (OCT). Initial workup revealed mild leukocytosis, eventually diagnosed as chronic lymphocytic leukemia (CLL). No other cause of optic neuropathy was identified despite extensive investigation. The patient developed rapidly progressive retinal ganglion cell nerve fiber layer (NFL) atrophy and relative afferent pupillary defect (RAPD) of the left eye despite steroid treatment but stabilized after four cycles of CLLtargeted chemotherapy. Although infiltrative optic neuropathy is well-known in leukemia, presentation with only subtle vision loss is rare. Vision loss usually presents late in leukemic infiltrative optic neuropathy and therefore must be considered in patients with optic disc swelling and leukocytosis.

Conclusion: When treating CLL, progressive visual decline with coexistent optic neuropathy may warrant chemotherapy.

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