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   Table of Contents      
CASE REPORT
Year : 1984  |  Volume : 32  |  Issue : 4  |  Page : 239-241

Acute proptosis in myeloid leukaemia


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
A Panda
Dr. Rajendra Prasad centre for Ophthalmic Sciences, A.I.I.M.S. New Delhi110 029
India
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Source of Support: None, Conflict of Interest: None


PMID: 6599841

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How to cite this article:
Panda A, Dayal Y. Acute proptosis in myeloid leukaemia. Indian J Ophthalmol 1984;32:239-41

How to cite this URL:
Panda A, Dayal Y. Acute proptosis in myeloid leukaemia. Indian J Ophthalmol [serial online] 1984 [cited 2019 Nov 12];32:239-41. Available from: http://www.ijo.in/text.asp?1984/32/4/239/27398



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Orbital or subconjunctival infiltration is common in acute or chronic lymphatic leukaemia, but both are rare in myelogenous leukaemia.[1] Out of 33 ocular anomalies listed in leukaemia the largest lesions were seen in fundus[2] & proptosis is very rare[3]. Similarly Crawford[4] found only 6 proptosis cases in children. However there are few reports of unilateral and bilateral proptosis due to leukaemic deposits in case of acute myeloid leukaemia.[1],[5],[6],[7],[8].

The aim of this paper being to report four cases of unilateral proptosis in acute myeloid leukaemia. The diagnosis was confirmed by peripheral blood smear and bone marrow examination. The salient features of the cases are as shown in [Table - 1].


  Discussion Top


Orbital infiltration in myelogenous leukaemia is very rare as compared to lymphatic leukaemia.[9] Acute mycloblastic leukaemia may occur at any age, although they are most commonly found in young adults, where as acute lymphatic leukaemia is a disease of childhood.[10] All four of our cases belong to the age group less than 12 years. In all types of leukaemia, a slight predominance of male patient is found (3:2)[10], which is also true in our cases (3:1). The mode of presen­tations in such cases are usually rapidly developing fatigue, general sense of pool health, often accompanied by haemorrhagic manifestations and fever. Two of our cases presented to us with history of rapidly progressing unilateral proptosis, one with unilateral proptosis where the trauma was thought to be the offending cause and, fourth with history of progressive painful bilateral proptosis.. Case number one was having an additional problem of incontinence of urine, which also suggested that the leukaemic deposits were over the vertebrae, thus com­pressing the urinary system. The cause of pro­ptosis may be due to orbital infiltration by leukaemic cells where the onset is graduals[9],[11],[7],[12] or due to haemorrhage in the orbit where the onset is very acute. It is felt that the cause may be due to orbital infiltration by leukaemic cells as they responded well to radiotherapy. As four of our cases were diagnosed only by peripheral smear it can be suggested that any case of proptosis either unilateral or bilateral should have a peri­pheral blood smear and the blood slide should be seen by an experienced haemat­ologist.-Similarly the possibility of leukaemic infiltration into the orbit should be remem­bered as a possible cause of proptosis in children.


  Summary Top


Four cases of acute myeloid leukaemia, three with unilateral and one with bilateral proptosis were described. All the patients were below 12 years of age. The diagnosis was confirmed by peripheral blood smear exami­nation. Incontinence of urine in one was sug­gestive of leukaemic deposit over the vertebrae.

 
  References Top

1.
Chatterjee B.M. and Sen N.N., 1960, Brit. J. Ophthalmol.  Back to cited text no. 1
    
2.
Gold back, 1933, Arch. Ophthalmol. 10:808.  Back to cited text no. 2
    
3.
Crombie A.L.. 1967, Brit. J. Ophthalmol. 51:101.  Back to cited text no. 3
    
4.
Crawford J.S., 1952, Trans. Acad. Ophthalmol. 10:808.  Back to cited text no. 4
    
5.
Bajal G.C., Agarwal N.L., Charu Gowcnde and Gupta D.C., 1979, Ind. J. Ophthalmol. 26:53.  Back to cited text no. 5
    
6.
Anna Thomas and Sujatta S., 1975, Aast Arch Ophthalmol. 3:4.  Back to cited text no. 6
    
7.
Consul B.N., Kulshreshtha O.P. and Mehrotra A.S.. 1967, Brit. J. Ophthalmol. 51:65.  Back to cited text no. 7
    
8.
G.N. Seal and A.K. Gupta, 1973, Ind. J. Ophthal­mol. 21:73.  Back to cited text no. 8
    
9.
Duke Elder S., 1974, System of Ophthalmology Henry Kimpton Vol. XIII. Part 11.  Back to cited text no. 9
    
10.
Reese A.B. and Long L.. 1933, Amer. J. Ophthal­mol. 16:718.  Back to cited text no. 10
    
11.
Reese A.B., 1963. Tumors of the eye. Harper and Row 3rd edition.  Back to cited text no. 11
    
12.
Aly Mortada. 1963, Amer. J. Ophthalmol. 55:327. 13. Harrison T.R., 1974, Principle of internal medicine Graw Hill Kogakusha Ltd. 7th edition.  Back to cited text no. 12
    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1]



 

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