Exploring the ocular involvement in multiple myeloma: a comprehensive review of 70-year clinical studies

To review the ocular symptoms and the related physiopathology in patients diagnosed with multiple myeloma (MM) to evaluate whether the ocular manifestations can be considered a disease hallmark that can guide the clinician's decision-making.

A comprehensive review of three databases (PubMed, Scopus, Embase) was conducted until April 25, 2024. Studies reporting intra- or extraocular manifestations of MM were included, excluding cases of other monoclonal gammopathies or therapy-related ocular effects. After screening 1873 initial results and hand-searching references, 82 articles were included.

Ophthalmic manifestations may be the first sign or represent MM relapsing. Several eyelid manifestations have been reported, including bilateral eyelid ecchymosis, cutaneous xanthomatosis, necrobiotic xanthogranuloma, localized lipid deposits, ptosis associated with diplopia, and eyelid ectropion. Several reports have reported crystalline deposits throughout all layers of the cornea, including the epithelium, stroma, and endothelium of MM patients. In addition, copper deposition that appears as a greenish-brown deposit affecting the central cornea on Descemet's membrane with unique characteristics has also been rarely reported in MM patients. Beyond anterior segment involvement, the retina and choroid can also be affected in MM with bilateral central retinal vein occlusion, choroidal effusion, ciliary body cysts, Purtscher's retinopathy, and microvascular changes.

Early recognition of MM's ophthalmic manifestations is essential to establish an early diagnosis and treatment. Hence, all patients diagnosed with MM 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.