Cloudy corneas as an initial presentation of multiple myeloma

Abstract

Priyanka Sharma,1 Haifa A Madi,1 Richard Bonshek,2 Stephen J Morgan11Sunderland Eye Infirmary, Sunderland, UK; 2National Specialist Ophthalmic Pathology Service, Department of Histopathology, Manchester Royal Infirmary, Manchester, UKSummary: We report a case of previously unsuspected myeloma, presenting with cornea verticillata due to intracorneal paraprotein deposition.History: An 85-year-old female presented via her optician with a 4-month history of cloudy vision. She had undergone an uneventful bilateral phacoemulsification surgery 7 years earlier. Extensive spiraling corneal epithelial opacification was noted on slit-lamp examination. On further investigation, she was found to have a previously unsuspected low-grade multiple myeloma. We established the nature of the corneal deposits with corneal epithelial biopsy histopathology and electron microscopy. It is very rare for multiple myeloma to present in this fashion. Ophthalmologists should be aware that such a presentation may rarely be due to systemic multiple myeloma.Keywords: corneal crystals, multiple myeloma, crystalline keratopathy, vortex keratopathy