Bilateral Orbital Involvement with Severe Visual Impairment and Anterior Staphyloma in a 13-year-old boy with Acute Myeloid Leukaemia: A Case Report

Background: Acute myeloid leukaemia (AML) is a haematological malignancy that can involve extramedullary tissues, including the orbit and ocular structures. Orbital leukemic infiltration is an uncommon but potentially vision-threatening manifestation, particularly in paediatric patients. Case Presentation: A 13-year-old male with a known history of acute myeloid leukaemia presented with gradually progressive swelling of the eyelids in both eyes over eight months. The patient had previously received four doses of chemotherapy and radiation therapy and was undergoing oral metronomic treatment. Ophthalmological examination revealed severely reduced visual acuity, limited to hand movement perception (HM+) in both eyes. Anterior segment examination documented bilateral localized anterior staphyloma. B-scan ultrasonography revealed vitreous echoes, structural ocular changes, and orbital findings suggestive of leukemic infiltration. Flash visual evoked potential testing was also performed to assess visual pathway function. Diagnosis: Based on the clinical history, ophthalmological examination, and ultrasonographic findings, bilateral orbital leukemic involvement was clinically assessed in association with localized anterior staphyloma. Management and Outcome: The patient underwent multidisciplinary ophthalmological evaluation, including recommendations for oculoplastic and corneal consultations. A guarded visual prognosis was explained, and further ocular surgical intervention was considered in relation to the patient's systemic condition. Subsequent treatment response and visual outcome were not documented in the available records. Conclusion: This case highlights the importance of comprehensive ophthalmic evaluation in children with acute myeloid leukemia presenting with persistent eyelid swelling and severe visual impairment. Early recognition of suspected orbital leukemic infiltration, appropriate ocular imaging, and coordinated multidisciplinary management are essential for clinical assessment and treatment planning.