Leukemic infiltration of the optic nerve

Leukemic infiltration of the optic nerve is an uncommon condition, although its incidence has increased as more effective oncologic and supportive therapy has improved survival among patients with leukemia. Since both the central nervous system and the eye are immunoprivileged sites, they may not be reached by systemic chemotherapy. Therefore, leukemic cells can be harbored in these spaces, even when treatment has eliminated the leukemia elsewhere in the body. Furthermore, when leukemic cells infiltrate the ocular structures, including the intraocular portion of the optic nerve, even intrathecal chemotherapy may not be adequate to eliminate them. Due to the rarity of leukemic infiltration of the optic nerve, there are no randomized controlled trials or other prospective studies evaluating its management. However, treatment with whole brain and directed optic nerve radiation, along with intrathecal chemotherapy and steroids, may be successful for preserving vision or preventing further vision loss, while also treating the underlying disease.