We present the case of a 45-year-old patient admitted to the haematology department for Ig G Kappa stage III-A MM IgG with hepatic infiltration. He had no personal or family history of interest.
The patient was referred to the Ophthalmology Department for a red right eye (OD) of 24 hours' evolution with no other visual or ocular symptoms.
Visual acuity was equal in both eyes and the slit lamp showed a painless, vascularised, upper nasal subconjunctival mass in the right eye. The rest of the examination, including the fundus examination, was normal.
The lesion progressed in 48 hours, infiltrating the upper eyelid and causing ophthalmoplegia of the OD.
A computed tomography (CT) scan was performed showing soft tissue enlargement without bony lesions. Biopsy of the lesion showed plasma cell infiltration.
The patient was undergoing QT with Vincristine, Uracil, Cyclophosphamide, Melphalan and Prednisone followed by Vincristine, Uracil, Adriamycin and Dexamethasone. On biopsy confirmation local RT was added.
Despite treatment with QT and RT the infiltration continued to progress through the eyelids and conjunctiva, developing acute post-rabecular glaucoma with intraocular pressure (IOP) of 50 mm Hg which did not respond to oral (carbonic anhydrase inhibitors) and topical (beta-blockers and prostaglandins) treatment.
RT was discontinued and QT was replaced by Cyclophosphamide, Dexamethasone, Bortezomid and Adriamycin, followed by Methotrexate, Cytarabine and Methylprednisolane. This second line of QT resulted in remission of the infiltration within two weeks, normalisation of IOP with normal visual fields, although with residual ptosis and restriction of ocular motility. Despite remission of the ocular symptoms, the patient died after six months.