Abdul Majeed, M M Naseer Raja.
Acute Myeloid Leukaemia Presenting with Proptosis.
Pak J Ophthalmol Jan ;14(4):182-4.

A 7-Year-old girl presented to the Eye Department, Combined Military Hospital, Peshawar Cantt, with rapidly progressive proptosis affecting the left eye and generalized weakness of 15 days` duration. On examination, she had slight pallor and palpable left submandibular and cervical lymph nodes. There was soft, non-tender, 2 cm enlargement of the liver. On ophthalmic examination, the visual acuity was 6/6 and 6/9 (partial) in the right and left eyes, respectively. There was a giant non-pulsatile proptosis of the left eye with 15mm axial, 3mm downwards and 4mm nasal displacement of the eyeball. A firm, non-tender mass was palpable at superolateral margin of the orbit, with no bruit and undefined posterior margin. Lid closure was incomplete, except on forceful blinking. Ocular motility was restricted in all directions of gaze. Conjunctiva was chemotic and congested. Rest of the anterior segment was normal. Funduscopy revealed folds at the left macula. Serial laboratory workup revealed leucocytosis of 1200-1600/ul with relative lymphocytosis (64% lymphocytes). Differential leucocyte count (DLC) revealed 15% neutrophils, 30% lymphocytes and 55% atypical mononulcear cells with monocytoid features. llaving such a DLC profile, bone marrow examination was advised which revealed acute myeloblastic leukaemia. Ultrasonography of the orbit revealed a hypoechoic mass 3.3cm x 1.5cm posterolateral to the eyeball. Computerized tomography (C.T.) scan revealed a left retrobulbar and lateral orbital mass, pushing the eyeball forwards and inwards with no evidence of intracranial extension. The girl is being treated by the oncologist with chemotherapy, using a combination of cytotoxic agents. Proptosis is being managed by bland ointments during the day time and patching at night to avoid exposure keratopathy.

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