Leukemia is a group of cancers that start in blood-producing cells in your bone marrow and quickly spread to your blood. Leukemia can cause symptoms that affect many parts of your body, such as your eyes.

Estimates on how common eye involvement is in people with leukemia vary widely from 9% to 90%. In rare cases, eye involvement can be the initial sign of leukemia after diagnosis or relapse.

Some cases have linked leukemia to uveitis, which is inflammation of your uvea. Your uvea is the middle layer of your eye that contains three components:

  • Iris: the colored part of your eye
  • Ciliary body: a ring of muscles behind your iris that focuses your lens
  • Choroid: a part of your eye rich in blood vessels that connects your retina to the white of your eye

This article will cover how leukemia affects your eyes and specifically how it relates to uveitis.

Eye symptoms are well-documented complications of leukemia. When they occur, they usually occur in both eyes.

Symptoms involving your eyes can develop because of direct infiltration of leukemia cells to the tissue of your eyes or indirectly because of abnormal blood cell counts. Direct infiltration can occur in any part of your eye, including your uvea.

Direct infiltration of leukemia to your uvea can mimic uveitis. Uveitis is inflammation of your uvea.

It can cause symptoms that include:

It’s rare for symptoms involving your eyes to be the first symptoms of new or relapsed disease. But it does happen. For example, a 2021 case study reports a case of retinal detachment as the initial sign of acute lymphoblastic leukemia in a 74-year-old woman.

Rarely, leukemia can also lead to a leukemic hypopyon. That’s when white blood cells accumulate in the anterior chamber of your eye due to severe inflammation. Doctors often consider this an early sign of central nervous system involvement or relapse.

Types of leukemia

Doctors divide leukemia into many types depending on how quickly it develops and the type of cells it affects. Chronic leukemias tend to develop slowly, while acute leukemias develop quickly. Lymphocytic leukemias develop in a category of white blood cells called lymphocytes, and myeloid leukemias develop in cells that become red blood cells, platelets, or some white blood cells.

The four primary categories are:

In a 2015 study, researchers found that among 96 people with leukemia, eye symptoms occurred in 52.9% of myeloid leukemias and only 28.6% of lymphoid leukemias. They also found that eye symptoms occurred in 51.9% of people with acute leukemia but only 25% with chronic leukemia.

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A doctor or healthcare professional may suspect leukemia or another blood cancer is the cause of your uveitis if you’ve previously received a diagnosis of a blood cancer or you have other typical symptoms of these diseases.

An eye doctor can diagnose uveitis by performing an eye examination. Your examination may consist of:

  • vision assessment
  • fundoscopy, where your eyes are dilated with eye drops to examine the back of your eye
  • tonometry, an exam that measures your eye pressure
  • slit-lamp examination

A slit lamp is a microscope with a bright light. Eye doctors use it to look for abnormalities in the structures in the front and inside of your eye. A doctor can use a slit lamp to look for signs typical of blood cancers.

In a 2019 study, researchers concluded that all people with leukemia should receive an eye exam at the time of diagnosis since most people with eye involvement have no symptoms.

A bone marrow biopsy can confirm a leukemia diagnosis. A doctor may also order blood tests to look for signs of leukemia, such as abnormal blood cell counts.

Causes of uveitis

It isn’t always clear what causes uveitis. It can be due to cancers that affect your eye, such as lymphoma or leukemia. It can also be due to autoimmune diseases or immunodeficiency disorders such as:

Sometimes uveitis can be due to an infection or complications of an infection such as:

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Leukemia may not cause symptoms in the early stage. When symptoms do develop, they often include:

Uncontrolled inflammation in people with uveitis accounts for about 10% of blindness in the United States. Other potential complications include:

Treatment for uveitis depends on the underlying cause.

Steroids in the form of eye drops, injections, or tablets can help to lower inflammation. Other treatments include:

  • mydriatic eye drops if your uveitis affects the front of your eye
  • antibiotics, antifungals, or antivirals for infections
  • immunosuppressants for people who don’t respond to the above
  • surgery for severe or repeated uveitis

Current treatment for people with leukemia with eye involvement includes:

  • chemotherapy and biological treatments
  • irradiation, or radiation therapy directly to your eye
  • injections with dexamethasone, antivascular endothelial growth factor, or methotrexate are under investigation

Here are some frequently asked questions people have about leukemia with eye involvement.

Can an eye exam detect leukemia?

Your eye doctor may be able to spot signs of leukemia during an eye examination. For instance, the American Academy of Ophthalmology presents the case of an eye doctor who noticed two small pinpoint hemorrhages on the retina of a 15-year-old boy that turned out to be leukemia.

Can leukemia medication cause uveitis?

Chemotherapy is a typical treatment for leukemia. Some types of chemotherapy can potentially damage your eyes. In a 2018 study, researchers observed three people with uveitis during cytarabine and daunorubicin treatment for acute myeloid leukemia among 55 people suspected of having eye damage due to chemotherapy.

Can leukemia cause eye cancer?

Leukemia can cause an eye tumor or other symptoms that affect your eye. Studies have reported eye symptoms in anywhere from 9% to 90% of people with leukemia.

Leukemia can cause symptoms that affect your eye, including uveitis. Uveitis is inflammation of the middle layer of your eye called your uvea.

Uveitis can have many different causes. If you notice any potential symptoms of uveitis, such as blurry vision, floaters, or unexplained eye pain, it’s important to get medical attention from your eye doctor for a proper diagnosis.