Ophthalmic manifestations of multiple myeloma.

BACKGROUND: The ophthalmic manifestations of multiple myeloma can be seen in practically every ocular structure. Ocular findings may be the first manifestations of the disease. It may also occur as one of the extramedullary manifestations of the disease or as the first sign of insufficient chemotherapy. Multiple myeloma may cause ocular pathology by direct infiltration or as extramedullary plasmacytomas resulting in displacement or compression of tissues, by causing hyperviscosity syndrome, and by immunoglobulin light chain deposition in ocular tissues.
OBJECTIVE: To outline the ophthalmic manifestations of multiple myeloma.
METHODS: Information about multiple myeloma and ophthalmic manifestations was obtained from original journal articles, review articles, case reports and standard postgraduate textbooks.
RESULTS: Ophthalmic manifestations include proptosis, diplopia, lid ecchymosis, xanthomatosis, conjunctival and corneal crystalline and non-crystalline deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vasculitis, detachment of sensory retina and retinal pigment epithelium, and neuro-ophthalmic manifestations.
CONCLUSIONS: In multiple myeloma, it is necessary to take a closer look at the ophthalmic manifestations, both because of their local morbidity and because they might act as a reservoir for proliferation of myeloma cells and eventual systemic relapse. Early detection may permit safer and effective treatment. All patients with multiple myeloma should thus undergo thorough ophthalmic examination at the time of initial diagnosis and during follow-up.