Corneal Crystalline Deposits in a Patient with Multiple Myeloma
A 66-year-old woman presented to the eye hospital with a 6-month history of photophobia and blurry vision. On physical examination, the visual acuity was 20/25 in the right eye and 20/30 in the left eye. Diffuse corneal clouding by crystalline deposits with multicolored reflectivity was seen in the corneal stroma of both eyes on slit-lamp examination (Panels A and B). The rest of the eye examination was normal. Corneal crystalline deposits may occur in the context of primary ophthalmologic conditions, such as ocular infections or corneal dystrophy, or in the context of systemic diseases, such as cystinosis or paraproteinemias. Owing to concern for an underlying systemic condition, laboratory testing was performed, which showed a new normocytic anemia. The patient was subsequently referred to a hematologist for further evaluation, and IgG kappa multiple myeloma was ultimately diagnosed. A final ophthalmologic diagnosis of corneal immunoglobulin deposition due to multiple myeloma was made. The patient was treated with chemotherapy and autologous hematopoietic stem-cell transplantation. At follow-up 1 year after the transplantation, the corneal clouding had resolved and the patient’s vision had returned to normal.