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Acute lymphoblastic leukemia (ALL) is a disorder caused by the abnormal proliferation of immature lymphocytes. Of the varied ocular manifestations seen in ALL, infiltration of the optic nerve is a rare and serious complication that heralds a relapse of the disease. It requires a high index of suspicion for diagnosis. Urgent intervention may prove to be lifesaving. We describe a case of optic neuropathy in a 12-year-old boy with ALL and wish to emphasize the need to maintain a low threshold for diagnosing optic nerve infiltration in patients with a prior history of leukemia.

A 55-year-old female presented with a defective vision since childhood. The fundus examination revealed a well-demarcated macular excavation of 2 1/2 disc diameters. Optical coherence tomography (OCT) of both eyes revealed a bowl-like depression at the macula, absence of retinal pigment epithelium, and choroid with atrophic neurosensory retina. She was diagnosed as a case of bilateral macular coloboma. We wish to stress OCT and multimodal imaging's importance to diagnose macular colobomas and differentiate it from other disorders of the macula.