Unilateral Exophthalmos as the Presenting Sign in Leukemia

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UNILATERAL EXOPHTHALMOS rarely occurs as the initial sign of leukemia, although exophthalmos occasionally develops during the course of leukemia —Reese1 reports the occurrence in 2 per cent of patients having lymphocytic leukemia. Since it is usually the ophthalmologist who is called upon to determine the cause of exophthalmos, the fact that it may be the presenting sign in unsuspected leukemia is of particular importance to him. The present report describes two unusual cases in which unilateral exophthalmos was the first sign of leukemia. These occurred in two seven-year-old children, a boy and a girl. The exophthalmos was persistent in the boy and intermittent in the girl.

Report of Cases

Case 1. A seven-year-old boy was first examined in the Department of Ophthalmology on November 6, 1952. His parents stated that he had had some protrusion of the right eye for about two weeks, but that his general health had been excellent (Fig. 1 a).

Table 1 gives the results of the ocular examination. No mass was palpable, and bruit was questionable. Examinations of the extraocular muscles and the ocular fundi revealed no abnormalities.

The patient was examined in the Department of Neurological Surgery by Dr. W. James Gardner, and no evidence of intracranial pathology could be found. The examination by Dr. Harold E. Harris of the Department of Otolaryngology disclosed no evidence of mucocele or of other pathologic condition in the sinuses.

Laboratory studies revealed a red blood cell count of 3,700,000 and a white blood cell count of 6,150. . .



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