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• #Kaleidoscope vision stroke skin

While the hematologist is primarily responsible for the treatment plan, it is imperative that an ophthalmologist help co-manage the patient’s symptoms. Monoclonal gammopathy of undetermined significance (MGUS)Īn ophthalmologist who suspects MM should refer the patient to a hematologist for further evaluation.

If no end organ damage, then clonal plasma cells> 60%.ěone Lesions: Lytic lesions, severe osteopenia, pathological gestures.Ěnemia: hemoglobin2g/dL below lower limit of normal.

#Kaleidoscope vision stroke skin

Papillademea, Abducens (CN VI) Palsy Įasy bruising in the skin around the eyes Ophthalmic signs: Table 1 below demonstrates previously reported signs grouped by anatomic region:įorwardly displaced eye. Ophthalmic Symptoms: Ocular symptoms may include diplopia, pain or pressure in the eye, ptosis, proptosis, or loss of vision. Ionizing radiation, benzene, and herbicides may increase the risk for MM. The median age of diagnosis is between 65-70 years. MM is a common hematological malignancy, accounting for nearly 10% of blood related malignancies. When the viscosity of the blood rises beyond 4 centipoise, an ocular thrombotic event (e.g., central retinal vein occlusion) may occur. Poiseuille’s Law states that resistance to flow in a pipe is directly proportional to the viscosity of the liquid in the pipe. Gertz et al proposed that the primary determinant of viscosity levels in serum and plasma is protein (e.g., Ig) levels. The second mechanism is hyperviscocity from elevated Ig. This can induce compression of the surrounding structures, leading to several of the pathologies indicated in Table 1. Neoplastic infiltration of the surrounding orbital tissue can lead to the development of mass lesions. The first mechanism is direct infiltration of the ocular tissues. There are two prominent hypotheses for the ocular manifestations of MM. The combination of these genetic abnormalities is responsible for nearly 90% of MM. Cytogenetic changes in MM include activation of oncogenes (e.g., cyclin D1 on chromosome 11q13, cyclin D3 on chromosome 6q21, and maf-B on chromosome 20q11)5 and translocation of one of these oncogenes to the Ig heavy chain locus (located on chromosome 14).5 In addition to the proliferative changes, over-expression of BCL-2 has been implicated in MM due to the resultant decrease in rates of apoptosis. The rate of change of the light chains as a whole as well the kappa to lambda ratio can be monitored to detect disease severity. As MM progresses, the light chains are produced in excess relative to the heavy chains. The light chain can either be kappa or lambda. In multiple myeloma, IgG or IgA levels are usually elevated. Depending on which plasma cell is proliferating, one of the five heavy chains will be overproduced. There are five types of heavy chains: IgG, IgM, IgA, IgE or IgD. Ig contain two heavy chains and two light chains. Normally, plasma cells are produced from B-lymphocytes, which produce Ig against infection. MM results from an uncontrolled proliferation of plasma cells. MM has multi-organ system manifestations and can present with multiple ocular symptoms and signs (including the eyelid, iris, cornea, retina, optic nerve and brain ). In MM, there is abnormal proliferation of malignant plasma cells, leading to overproduction of specific Ig lineages. Plasma cells produce immunoglobulins (Ig), which are integral to the humoral immune response. Multiple myeloma (MM) is a hematologic neoplastic disorder that results from proliferation of malignant plasma cells.