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Year : 1971  |  Volume : 19  |  Issue : 3  |  Page : 143-144

Bilateral proptosis with acute myeloid leukaemia

Department of Ophthalmology and Pathology, Medical College, Jabalpur, M.P, India

Correspondence Address:
S H Hafeez Ahmad
Department of Ophthalmology and Pathology, Medical College, Jabalpur, M.P
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Source of Support: None, Conflict of Interest: None

PMID: 15744986

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How to cite this article:
Hafeez Ahmad S H, Mishra R K, Agarwal S. Bilateral proptosis with acute myeloid leukaemia. Indian J Ophthalmol 1971;19:143-4

How to cite this URL:
Hafeez Ahmad S H, Mishra R K, Agarwal S. Bilateral proptosis with acute myeloid leukaemia. Indian J Ophthalmol [serial online] 1971 [cited 2021 May 11];19:143-4. Available from: https://www.ijo.in/text.asp?1971/19/3/143/34975

Bilateral proptosis is fairly com­mon in association with acute and chronic lymphatic leukaemia, and it has been observed to occur in 2 percent cases by Reese and Guy [6] on the other hand myelogenous leukaemia rarely gives rise to proptosis (Wright [8] and Duke Elder [3] Wright [8] reported a case of prop­tosis with myeloid leukaemia as­sociated with fever in a 4 years old Indian child. Chatterji and Sent observed proptosis in the right eye only in a case of acute mye­loid leukaemia. Wright [8] further stated that the common cause of proptosis in leukaemia cases was spontaneous orbital heamorrhage. The following is the report of a case of acute myeloid leukaemia with an early presenting symptom of bilateral proptosis.

  Case Report Top

A Hindu male child aged 11 years attended the ophthalmic depart­ment of Medical College Hospital, Jabalpur, M.P. on 3-2-1970 with a history of swelling of both upper lids and prominence of eye balls since a week. History of fever off and on since last 15 days.

Local Examination

Vision right eye 6/24 and left eye 6/9. Reaction of the pupils direct and indirect were normal. The upper lids were full and tense, showing no adhesions un­derneath. A hard mass was felt within the supra-orbital margins. The mass was fixed, irregular and no tenderness was noticed. Both eye balls were pushed forwards and slightly downwards with res­tricted movements all round. [Figure - 1].

Fundus Examination

Media were clear in both eyes. Bilateral papilloedema (3D) and retinal oedema were present, but no heamorrhages or exudates were seen.

General Examination

There was no enlargement of liver, spleen or lymph nodes. The air sinuses were normal. The boy were normal.


Haemoglobin 8 gm. %. Total leucocytes 20,000 per cent. There was anisocytosis. Platelets were reduced in number.

Peripheral blood film showed, blast cells 58%, myelocyte 2%, Stales cells 8 % polymorph 11%, lymphocyte 20%, monocyte 1%,).

Peroxidase staining showed posi­tive results (Presence of granules in the immature cells).

Bone marrow biopsy showed M.E. ratio to be 10: 1 with pre­dominant myeloblasts.

Liver biopsy did not show leu­kaemia infiltration or any other specific change.

Blood cholesterol - 115 mgm. E.S.R. 55 mm at the end of 1st hour. BMR (+14). Urine exa­mination: no abnormality was detected. X'ray of the skull and orbit did not show any positive findings.

  Discussion Top

Acute myeloid leukaemia may manifest with diffuse infiltration in various organs or rarely in localized deposits of leukaemic cells. This case came to us with bilateral moderate proptosis, with­out any other local or general symptoms.

Therefore investigations like blood cholesterol, B.M.R. and X'­ray of the orbit were done to find out the cause of proptosis. They did not reveal any positive find­ings. The peripheral blood film and the bone marrow examinations clinched the diagnosis of acute myeloid leukaemia. With a view to diagnosing such cases correctly and in time Cromble [2] suggests that in all cases of orbital proptosis, even if peripheral blood count and film are not greatly abnormal, a bone marrow biopsy should be performed.

Duc and Wright [8] have observed that Myelogenus leukaemia does not give rise to proptosis except as a great rarity. Usually the cause of proptosis in these cases is spontaneous orbital heamorrhage. Reese and Guy [6] also reported a case of Myelogenous leukaemia in which choroidal heamorrhage was the cause of acute proptosis.

Osterwald and Schiotz [3] report­ed papilloedema as a rare compli­cation in such cases. Chatterji and sen [1] observed a normal fundus in their case of acute myeloid leu­kaemia with proptosis. Leukae­mia is usually accompanied by the widespread systematic implica­tion of the lymph nodes, spleen, liver etc., but in this case the proptosis was not associated with any wide spread leukaemic inrll­tration.

  Summary Top

Acute myeloid leukaemia with bilateral proptosis (no orbital haemorrhage) and without syste­matic implication and with un­usual complications (papilloedema and retinal oedema) is reported. The diagnosis is established by pathological examinations.

  References Top

CHATTERJI and SEN: Acute Mye­loid Leukemia - Leukemic deposit in Orbit. British. J. Ophthal. 44, 441: (1960).  Back to cited text no. 1
CROMBIE - J. All Indian Ophthal Soc., Acute Bilateral proptosis. 16, 90, 1968. (Quoted by Sen, H. Mohan and Gupta).  Back to cited text no. 2
DUKE - ELDER S. (1952): 'Text Book of Ophthalmology'. Vol. 5, M. 5551 and 5552. Henry Kimpton, London.  Back to cited text no. 3
HAMEED S., DAS T. and AGAR­WAL K. C.: Chloroma of the Orbit, Brit. J. Ophthal. 43, 107: (1959).  Back to cited text no. 4
MORTADA: Amer. J. Ophthal. Or­bital Lymphoblastomas and Acute Leukemias in children. Vol. 35 - 1963, page 327.  Back to cited text no. 5
REESE A. B. and GUY. L. (1933): Exophthalmos in Leukemia Amer. J. Ophthal. 16, 718.  Back to cited text no. 6
SORSBY, A.: 'Systemic Ophthal.', p. 574, Butter worth, London. (1951)  Back to cited text no. 7
WRIGHT (1938) `Extra-ecular affection' Madras (Quoted by Duke elder 1952).  Back to cited text no. 8


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