Multiple Myeloma with Anemia and Thrombocytopenia
These are fundus photographs from a 56-year-old-man who presented with complaints of seeing a floater in his right eye. His visual acuity was 20/63 in the right eye and 20/20 in the left. He has multiple myeloma, a cancer that causes overproduction of plasma cells in the bone marrow and elsewhere in the body in more advanced cases. Associated problems include anemia and thrombocytopenia (low platelet count), which can lead to retinal hemorrhages. Optos fundus images show multiple dot hemorrhages from thrombocytopenic retinopathy in both eyes (white arrows). His complaint was caused by the hemorrhage in the right macula (yellow arrow). Optical coherence tomography scans show an inner retinal hyper-reflective lesion in his right eye (red arrow) whereas his left eye appeared normal. At this visit, he was receiving chemotherapy treatment every week, which can cause anemia and thrombocytopenia too. With sustained treatment, the hemorrhages and retinopathy should resolve and improve over time. He was asked to return in 8 weeks for monitoring.