Chronic myeloid leukemia masquerading as vitreous hemorrhage in the eye

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm that may present with ocular manifestations as the initial clinical sign. A 23-year-old male presented with sudden progressive diminution of vision in the left eye (LE) associated with left-sided headache for 3 weeks. His best-corrected visual acuity was 6/12 in the right eye (RE) and inconsistent perception of light in the LE. Intraocular pressures (IOPs) were 12 and 49 mmHg in the RE and LE, respectively. After primary evaluation, the differential diagnoses were RE blood dyscrasia-related retinopathy/anemic retinopathy/coagulopathy-related retinopathy/leukemic retinopathy and LE vitreous hemorrhage (VH). Further blood investigations, peripheral smear (PS), and BCR/ABL translocation confirmed CML. Initiation of Imatinib therapy led to worsening of clinical condition, worsening of RE stasis retinopathy, LE intercalary staphyloma, total hyphema, with corneal blood staining and raised IOP, posing a therapeutic dilemma.