Normal relative serum viscosity is 1.8. He had hyperviscosity retinopathy, which may manifest with vascular tortuosity and engorgement, exudates, deep and superficial hemorrhages and cotton-wool spots. The presence of white centered hemorrhages may be attributed to the presence of anemia, thrombocytopenia, and hyperviscosity, or a combination of these factors. Other ocular manifestations of multiple myeloma are attributed to direct infiltration by myeloma cells or to the deposit of monoclonal paraproteins in ocular tissues. 6 Myeloma may involve the orbit, conjunctiva, cornea, uvea, retina and scleral tissues.
Orbital involvement is uncommon.
However, proptosis may be an initial manifestation of the disease. Corneal crystals both in the stroma and in the epithelium have been described, and they are thought to represent immunoglobulin depositions. In the posterior pole both diffuse choroidal infiltrates of plasma cells and solitary choroidal plasmocytoma have been described. Deposits of proteinaceous material in multiple myeloma have been found in multiple cysts of the ciliary epithelium and under serous detachments of both the pigment epithelium and sensory retina. Optic disc swelling secondary to direct infiltration by the plasma cells or due to increased intracranial pressure caused by a CNS plasmocytoma has also been reported.