Key takeaways
- Multiple myeloma, a blood cancer, can lead to various eye problems due to complications such as hyperviscosity syndrome (thickened blood) or extramedullary disease (tumor growth outside the bone marrow).
- Eye issues can also result from multiple myeloma treatments, with some side effects being temporary and others causing permanent vision damage.
- It is crucial that you promptly report any vision changes to your healthcare team and have regular eye exams so that your doctors can detect and treat any potential problems early.
Multiple myeloma is a type of blood cancer that affects plasma cells. Although it initially develops in bone marrow, it can have widespread effects throughout your body, including on your eyes.
In this article, we explore some of the common eye symptoms that can develop in multiple myeloma and why they occur. We also discuss how myeloma treatments can affect eye health and what steps you can take to prevent or manage any eye-related complications.
Multiple myeloma can affect many parts of your eye and the surrounding eye socket (orbit), as well as blood flow and nerve activity within your eye. As a result, you may experience a wide range of eye symptoms, depending on the underlying cause.
Eye problems that may develop as a result of multiple myeloma complications include:
- blurred vision
- pain or discomfort
- blind spots
- double vision or difficulty focusing
- loss of acuity (visual sharpness)
- bulging or swelling of your eyes or eyelids
- narrowing of your field of vision
- changes in color perception
- reduced eye mobility
- retinal hemorrhaging (bleeding) or detachment
In some cases, changes to your eye health or vision may begin before you even know that you have multiple myeloma. Some of these changes can start in myeloma precursor conditions, such as monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma.
If you have a multiple myeloma diagnosis, you should promptly discuss any eye problems with your healthcare team. Regular monitoring of your eye health is recommended so that doctors can detect any vision changes or other issues early.
In many cases, eye issues can be improved with multiple myeloma treatment or additional supportive care, which can help prevent long-term damage to your eye and permanent damage to your eye health.
Eye effects in multiple myeloma can develop for a variety of reasons. Most of them are rare, but some of the most common complications that can affect eye health are described below.
Hyperviscosity syndrome
Hyperviscosity syndrome is a condition that develops when large amounts of M protein (the abnormal antibody produced by myeloma cells) build up in your blood. This causes your blood to thicken, which can slow down blood flow throughout your body.
When this happens in the small blood vessels of your retina, it can lead to vision problems and retinal issues.
Changes in blood flow throughout your body can also cause other symptoms, such as:
- confusion
- dizziness
- stroke-like symptoms (e.g., slurred speech and weakness on one side of your body)
Hyperviscosity syndrome is a rare complication of multiple myeloma, but it’s
Extramedullary disease
Extramedullary disease involves the growth of myeloma cells outside of your bone marrow.
When these tumors (known as plasmacytomas) develop within the orbit or nasal cavity or in the bones of your eye socket, they can put pressure on your eye and limit its ability to move as it normally does. This can cause bulging of your eye, swelling of the eyelid, discomfort, or blurred vision.
In rare cases, plasmacytomas can put pressure on the nerve that serves your eye (the optic nerve). This is known as optic nerve compression and can affect the way your eye processes visual inputs. With optic nerve compression, you may experience visual changes like visual field defects or changes in color vision.
Orbital extramedullary disease is rare and typically responds well to anti-myeloma treatment. However, available evidence suggests it could be a sign of a worse disease outlook overall.
Almost all myeloma treatments can also cause eye problems. Some of these effects are mild and reversible, while others may cause permanent eye damage and vision loss.
The types of eye effects vary between myeloma treatments.
For instance, corneal effects are common with certain antibody-drug conjugates, particularly belantamab mafodotin. These types of effects can happen in up to 92% of people treated with these medications, according to a review of clinical trials.
Most cases are reversible and can be managed by adjusting the treatment dose, but some cases can be more serious.
Chimeric antigen receptor (CAR) T-cell therapies can also cause visual symptoms that typically develop as a result of neurologic side effects and swelling of the optic nerve. These typically manifest as light sensitivity or blurred vision.
Because myeloma is a disease of antibody-producing cells, many myeloma treatments target the immune system, which can also increase the likelihood of infections. Eye infections, such as conjunctivitis (pink eye), are common with many types of treatment.
Steroids are often used to manage eye effects caused by myeloma and its treatments. They are also an important part of many myeloma treatment regimens. Dexamethasone is a common steroid used in myeloma treatment plans.
However, long-term use of steroids can also cause serious eye complications like glaucoma and cataracts, which cannot be reversed or cured.
Both myeloma and its treatments can have a wide range of effects on eye health. Many of these effects are treatable or reversible, but some can be permanent. In some cases, visual symptoms may indicate more severe complications that can be life threatening.
Whether you have active myeloma or are in remission, you should report any vision changes to your healthcare team immediately. Regular eye exams are also recommended for all people with myeloma, which can help detect changes to your vision or eye health early.
Eye health should be monitored by an ophthalmologist, who can provide additional testing and imaging not typically offered by optometrists.