Leukemic Optic Neuropathy: Believe Your Eyes

Papilledema, or swelling of the optic nerve, is common in patients with leukemia. It is an unspecified diagnosis that can be related to several underlying conditions including leukemic infiltrates causing elevated intracranial pressure, prolonged corticosteroid therapy, or tumor infiltrates of the orbit or optic nerve. There can also be disk edema due to leukemic infiltration of the optic nerve head, causing swelling and pallor independently of elevated intracranial pressure. What is most concerning about papilledema due to leukemic infiltrates is that it depends upon seasoned clinical judgment given that diagnostic testing including CSF studies and imaging can be negative. Given its insidious nature, this can lead to devastating and irreversible consequences including blindness for patients.A review of 92 cases of optic neuropathy in leukemia patients found over 35 were deemed to be from leukemic optic neuropathy (LON).