How Can Leukemia Affect the Eyes?

Leukemia can have wide-ranging effects on your eyes, from subtle changes in vision to more noticeable symptoms. Knowing the signs of leukemia and its possible impact on your eyes will help you get prompt treatment and prevent permanent damage to the delicate ocular tissues.

We spoke to Adil Maqbool, MD, a medical researcher and peer-reviewer at The Lancet, to learn more about how leukemia affects the eyes.

Leukemia is a blood disorder that causes abnormal production of blood cells in the bone marrow. As diseased cells accumulate, they build up in the bloodstream and affect different body parts. When damaged cells collect in the eyes, they can cause a range of physical and ocular symptoms, including:

• Blurred or double vision

• Floaters in the field of vision

• Redness

• Swelling

• Eye pain

• Sudden changes in vision

• Sensitivity to light

Leukemia most often affects the retina, which is located in the back of the eye and is responsible for converting light into impulses that can be interpreted by the brain. When leukemia affects the retina, it can cause vision problems such as blurry vision and blind spots.

Leukemia can also affect other parts of the eye, including the

• Orbit: the bony cavity where your eye is located

• Iris: the colored part of your eye

• Optic nerve: the bundle of nerves that carries visual information from the eye to the brain

According to Dr. Maqbool, an eye exam can indirectly lead to a leukemia diagnosis. “As we know, leukemia can cause retinal layer damage, hemorrhages, and other associated complications such as cotton-wool spots and macular hemorrhages,” he said.

"When we find these findings during an eye exam without any other obvious causes, we can look for leukemia," Dr. Maqbool added. An eye exam can also help doctors identify related vision problems or complications that need to be monitored over time.

Uveitis is a condition in which the uvea − the eye's middle layer − becomes inflamed. Uveitis can be associated with leukemia. However, other conditions, such as infections and autoimmune disorders, can also cause it. Signs of uveitis include eye pain, redness, and blurred vision.

An optometrist or ophthalmologist can diagnose uveitis during a thorough eye exam. This often involves visual acuity testing and a slit lamp exam to look for signs of inflammation in the eye. When uveitis is present, your doctor will likely order additional tests to determine if the cause is related to an underlying medical condition.

In some cases, leukemia treatment can damage the eye and cause uveitis. Chemotherapy, radiation therapy, and even targeted treatments such as monoclonal antibodies can all lead to vision changes or inflammatory reactions in the eyes.

Other causes of uveitis include:

• Infection

• Inflammatory diseases

• Autoimmune disorders

• Trauma

• Complications of Uveitis

When left untreated, inflammation can have severe consequences. Uveitis can lead to vision loss and other problems, such as:

• Cataracts

• Glaucoma

• Cystoid macular edema (CME)

• Damage to the optic nerve

When uveitis is present with leukemia, your doctor will treat the inflammation with topical or systemic medications. Steroids (oral, topical, or injections), immunosuppressants, or biologic agents may be prescribed to reduce inflammation and prevent further damage to the eye.