Bilateral occlusion of the central retinal artery associated with hyperglobulinemia in hairy cell leukemia

A 49-year-old man with hairy cell leukemia experienced occlusion of both central retinal arteries in a 6-day period. Hyperglobulinemia was noted; however, immunoperoxidase studies failed to demonstrate that the hairy cells had produced the excess immunoglobulins. None of the other, more common, causes of occlusion of the central retinal artery were present. Plasmapheresis, in addition to more traditional methods of treatment, resulted in stabilization of the patient's vision. Subsequent fluorescein angiography revealed markedly diminished choroidal perfusion as well as delayed retinal perfusion. This appears to be the first account of bilateral occlusion of the central retinal artery secondary to a hyperviscosity syndrome, as well as the first description of ocular involvement by hairy cell leukemia. Speculation as to how the hyperglobulinemia related to the ocular manifestations is offered.