Conjunctival chronic lymphocytic leukemia presenting as bilateral chronic conjunctivitis

Area of Science:

• Ophthalmology
• Hematology
• Oncology

Background:

• Chronic lymphocytic leukemia (CLL) is the most common adult leukemia.
• Ocular manifestations of CLL are rare but can present as chronic conjunctivitis.

Observation:

• A 73-year-old female with a history of CLL presented with bilateral chronic conjunctivitis, including conjunctival injection, discharge, and follicular lesions.
• Initial treatment with topical antibiotics and steroids provided partial improvement, but follicular lesions persisted.
• Conjunctival biopsy confirmed chronic lymphocytic leukemia.

Findings:

• Conjunctival biopsy confirmed CLL, indicating a rare ocular manifestation.
• Treatment with ibrutinib, a bruton kinase inhibitor, led to marked clinical improvement.
• The patient's conjunctival symptoms, including persistent follicular lesions, resolved with systemic therapy.

Implications:

• This case highlights the importance of considering ocular manifestations in patients with a history of CLL.
• Conjunctival biopsy is crucial for diagnosing rare ocular presentations of leukemia.
• Bruton kinase inhibitors show promise in managing ocular CLL, offering a targeted therapeutic approach.