Title : Beyond the blood: A vision threatening ocular twist in all
Abstract:
Background: Acute Lymphoblastic Leukemia (ALL) is the most common childhood malignancy, while ocular involvement in leukemia is not uncommon, However, severe anterior segment findings such as acute onset proptosis with chemosis-induced exposure keratopathy are rare and underreported. Conjuctival chemosis ,lid edema-can occur due to systemic inflammation, fluid overload, or lymphatic obstruction.
Purpose: To report a rare presentation of exposure keratopathy secondary to acute onset proptosis with massive chemosis in a patient with ALL, underscoring the need for early ophthalmic evaluation and multidisciplinary care to prevent irreversible visual loss.
Method: A 8 year old female presented with complaints of fever, cough, cold, lower limb weakness, difficulty in passing urine & stools, protrusion of both eyes, Diminution of vision since 15 days and watering, pain, discharge, redness in both eyes since last 15 days.Radiological investigation suggestive of myeloid/granulocytic sarcoma/lymphoma age inappropiate cerebral atrophy with enlarged lymph nodes. Patient was advised all blood investigations, bone marrow biopsy and MRI brain and orbit.Flow cytometry done confirming the diagnosis of Lymphoblastic Leukemia, B-ALL. Based on history, clinical features and investigations patient was diagnosed with Bilateral axial proptosis with severe exposure keratopathy with overhanging chemosis in a case of Lymphoblastic Leukemia, B-ALL. Patient was started topically on antibiotic and cycloplegic eye ointment with lubricating eye ointments, systemic antibiotics with lid taping and colistatin based chemotherapy.
Result: Patient showed rapid and significant symptomatic relief after high dose systemic antibiotics and colistatin based chemotherapy.
Conclusion: This case highlights the interplay between systemic illness (B- ALL), supportive therapy side effects, and ocular surface vulnerability. Early intervention with supportive care can prevent vision- threatening complications. Routine eye exams should be considered in patients undergoing chemotherapy with risk factors for ocular surface disease.
