All ocular tissue can be involved in leukaemia. The eye changes can occur at any time during the course of leukaemia, or they can make up the presenting features of the disease. These changes are more common in the acute leukaemias than in the chronic types.
Two groups of ophthalmic manifestations are recognised in leukaemias. The first group consists of leukaemic infiltration of ocular structures, for example retinal and preretinal infiltrates or anterior chamber and iris deposits. All of these are quite uncommon. The second group of manifestations is considered to be secondary to the haematological changes, for example thrombocytopenia, increased blood viscosity and highly increased leucocyte count. These changes include subconjunctival haemorrhages and intraretinal haemorrhages, including white centred ones, cotton-wool spots,"slow flow retinopathy" (Figure 21.14) and retinal venous occlusions (especially CRVO).
Less common manifestations include choroidal infiltrations, and retinal and optic disc neovascularisations. Apart from eye changes, the vision can be impaired by
leukaemic infiltrates elsewhere in the visual pathway (leading to field defects).
Ocular disease can also occur as complications of treatment of the leukaemia, for example opportunistic infections such as herpes zoster, graft-versus-host reactions and intraocular haemorrhage.
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