From the Research
A chest X-ray is not typically indicated for patients with multiple sclerosis (MS) or leukemia who present with eye pain and weakness, as these symptoms are more likely related to the underlying conditions themselves rather than chest pathology. For MS patients, eye pain and weakness may indicate optic neuritis or disease progression affecting motor pathways, which would be better evaluated with neurological examination, MRI of the brain and spine, and possibly visual evoked potentials, as suggested by the study published in 2022 1. The use of optical coherence tomography is also increasingly recognized as a highly sensitive tool in detecting subclinical optic nerve changes in MS patients 1.
For leukemia patients, these symptoms could suggest central nervous system involvement, medication side effects, or infection due to immunosuppression. More appropriate initial investigations would include:
- Blood counts
- Ophthalmologic examination
- Neuroimaging
If respiratory symptoms such as cough, shortness of breath, or chest pain were also present, particularly in immunocompromised leukemia patients, then a chest X-ray would be warranted to rule out pulmonary infections or leukemic infiltrates. The diagnostic approach should be guided by the patient's complete clinical presentation, with imaging studies directed at the most likely source of symptoms rather than performed routinely without specific indications, as supported by the principles outlined in the study on vision disturbances in multiple sclerosis 2.
It's also worth noting that optic neuritis, a common manifestation of MS, can lead to severe visual impairment despite corticosteroids, and plasma exchange has been shown to lead to significant visual recovery in some cases 3. The management of optic neuritis and other ocular manifestations of MS should be based on the latest clinical guidelines and evidence, including the use of intravenous steroids as recommended by the Optic Neuritis Treatment Trial (ONTT) 4.