Ocular clues to multiple myeloma

(Image Credit: ADobeStock/Witoon)

The results of a recent study¹ emphasized the importance of early recognition of the ocular signs of multiple myeloma. Early diagnosis and treatment may have a positive impact on the disease course, according to coauthors Matteo Ripa, MD, and Chiara Schipa, MD, who, respectively, are from the Department of Ophthalmology, Sankara Eye Hospital, Jaipur, Rajasthan, India; and the department of emergency, anesthesiological, and reanimation sciences at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico in Rome.

Multiple myeloma is a rare cancer that originates in white blood cells (plasma cells) that produce antibodies. The investigators conducted a literature review of PubMed, Scopus, and Embase to identify studies mentioning intraocular or extraocular manifestations of multiple myeloma with the goal of determining if they can be considered a disease hallmark to guide clinical decision-making. The researchers excluded cases that had other monoclonal gammopathies or therapy-related ocular effects. Ultimately, the investigators included 82 articles.

Ripa and Schipa and their colleagues reported that “Ophthalmic manifestations may be the first sign or represent that the multiple myeloma is relapsing.”

The literature search showed that several eyelid manifestations have been recognized, which included “bilateral eyelid ecchymosis, cutaneous xanthomatosis, necrobiotic xanthogranuloma, localized lipid deposits, ptosis associated with diplopia, and eyelid ectropion,” they said.

Other findings included the presence of crystalline deposits throughout all layers of the cornea, including the epithelium, stroma, and endothelium of patients with multiple myeloma. A rarer finding in patients with multiple myeloma was copper deposition that was described as a greenish-brown deposit affecting the central cornea on Descemet membrane with unique characteristics.

The investigators also found that the retina and choroid can be affected in this patient population. Specifically, bilateral central retinal vein occlusion, choroidal effusion, ciliary body cysts, Purtscher retinopathy and microvascular changes have been reported.

The research team underscored the importance of recognizing the ocular manifestations in patients with multiple myeloma to facilitate early diagnosis and treatment. The authors concluded, “…all patients diagnosed with multiple myeloma should undergo a thorough ophthalmic examination. Therefore, a close collaboration between hematologists and ophthalmologists could lead to earlier diagnoses and potentially impact the course of the disease.”

Reference

1. Ripa M, Schipa C, Aceto P, Shah NA. Exploring the ocular involvement in multiple myeloma: a comprehensive review of 70-year clinical studies. Int Ophthalmol. 2025;45. https://doi.org/10.1007/s10792-025-03467-9