Recalcitrant Optic Nerve and Retinal Infiltration in a Relapse of Acute Lymphoblastic Leukaemia

Isolated ocular relapse of leukaemia is rare. We present the case of a 20-year-old male with T-cell acute lymphoblastic leukaemia (ALL) who reported sudden blurring of vision in both eyes 6 months after documentation of ALL remission. Ocular examination showed bilateral infiltrative optic neuropathies and serous retinal detachments. Cerebrospinal fluid and bone marrow samples were negative for blast cells. Systemic work-up did not reveal any other sites of involvement. The ocular infiltration partially responded to reinduction chemotherapy, intraconal steroids, and radiotherapy. This report demonstrates a challenging case of isolated ocular ALL relapse presenting as bilateral optic nerve and retinal infiltration.