Maurice F. Rabb » Leukemia

This 44 year old man had a three week history of progressive loss of central vision in the right eye. He had noticed headaches, fatigue, irritability and loss of appetite for one month. He had experienced frequent dizzy spells for six months. A recent minor skin laceration had bled intermittently for several hours.

The visual acuity measured Hand Motion OD and 20/40 OS. The applanation pressures were 10mm OD and 12mm Hg OS. There was a right afferent pupillary defect. Conjunctival edema was present bilaterally with sludging of red cells in the vessels. There was no rubeosis.

The fundus examination of the right eye revealed dilated and tortuous veins, a large neurosensory detachment of the macula, numerous microaneurysms and extensive blot retinal hemorrhages in the mid-periphery. Similar findings were present in the left eye except for the neurosensory detachment.

Initially, I thought the patient might have leukemia and ordered a partial hematology profile.