Purpose:
To investigate and categorize the indications and ocular findings amongst inpatients with leukemia admitted at a Boston tertiary care hospital for which an ophthalmology consultation was requested.
Methods:
The records of all inpatient ophthalmology consultations requested at the Brigham and Women’s Hospital were retrospectively reviewed from October 2009 to June 2011. Records of those patients with a diagnosis of acute or chronic leukemia were identified. Data collected included patient demographics, reasons for ophthalmology consultation, ocular diagnosis, and exam findings.
Results:
Of the 890 ophthalmology consultations performed at the Brigham and Women’s Hospital over a 21-month period, 55 consults (6.2%) were requested for patients with a diagnosis of leukemia. The subtypes of leukemia identified were: acute lymphocytic leukemia (10, 18%), acute myelogenous leukemia (28, 51%), chronic lymphocytic leukemia, (12, 22%), and chronic myelogenous leukemia (5, 9%). The mean patient age was 52.3 years (range 22-81 years). There were 31 males and 24 females. In order of decreasing frequency, the top reasons for ophthalmologic consultation were to rule out ocular involvement in patients with fungemia (13, 23%), seeing floaters (11, 20%), decreased vision (9, 16.4%), and eye redness (5, 9%). A normal eye exam was found in 14 patients (25%). Anterior segment findings included dry eyes (7, 12.7%), conjunctivitis (3, 5.5%), corneal abrasion (1, 1.8%), acute angle-closure glaucoma (1, 1.8%), and anterior uveitis (1, 1.8%). Posterior segment findings included intraretinal hemorrhages (16, 29%), macular hemorrhage (3, 5.5%), vitreous hemorrhage (2, 3.5%), and cotton-wool spots (1, 1.8%). Other findings included 2 patients with preseptal cellulitis, one with dacrocystitis, and one with an orbital mass. Eleven patients had a bone-marrow transplant and 11 had a stem-cell transplant. Among the 10 patients with known graft-versus-host disease, four patients had ocular manifestations (1 pseudomembranous conjunctivitis, 3 dry eyes).
Conclusions:
Ophthalmologic consultation is commonly requested for inpatients with leukemia, and ophthalmologists provide a valuable service to these patients.