Abstract
We are reporting the case of a 3-year-old-girl who initially presented with unilateral eyelid swelling and ptosis. A diagnosis of acute lymphoblastic leukaemia (ALL) was eventually made based on an orbital incisional biopsy and a bone marrow examination. Historically, orbital involvement had been linked to myeloid leukaemia; however, in lymphoid leukaemia, they are increasingly being implicated and had been reported as the sole presentation of the disease. These findings stress the importance of conducting ophthalmologic assessments in cases diagnosed with ALL in order to prevent delays in proper assessment and treatment. Management options in orbital disease are fortunately not significantly different than well-established treatment protocols.
Highlights
Leukaemia is described as a malignant proliferation of immature leucocytes which end up replacing the bone marrow, peripheral blood, and organ tissues with blast cells [1]
Orbital leukaemic tumours are characterized by their childhood age predominance [7]. ese presentations were more commonly associated with acute myeloblastic leukaemia (AML)
An ancient Turkish report published in e Lancet Journal in 1970 hypothesized that childhood myeloid leukaemia tends to be tumorous rather than diffuse and can cause chloroma like ocular mass [10]; another Turkish study published in Nature Journal in 2002 suggested that ocular involvement in myeloid leukaemia carries a poor prognosis even in the presence of favourable cytogenetics [11]
Summary
Leukaemia is described as a malignant proliferation of immature leucocytes which end up replacing the bone marrow, peripheral blood, and organ tissues with blast cells [1]. ALL is the most common childhood variant of leukaemia; it generally presents with pancytopenia and organ infiltrates [3]. Involvement of the eye in haematological malignancies can either present as the first manifestation of the disease or be part of a systemic infiltration by neoplastic cells [5]. Extramedullary infiltration involving the orbits caused by myelocytic and myeloblastic leukaemia is well established in the literature [6]. Lymphocytic and lymphoblastic leukaemia, have been reported to a lesser extent; this disease pattern is still sporadic and unique [3, 7]. In 1995, a report discussing eye involvement patterns of leukaemic tumours in patients from Jeddah, Saudi Arabia, was published [9]. There have been no further studies describing this uncommon disease presentation in Saudi populations. It is our hope that this report adds to the growing literature surrounding this disease and may help in influencing better screening and diagnosing strategies
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