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(1) Vascular Changes in the Retina.-The incidence of these events is unknown but changes severe enough to produce marked visual impairment are rare. A haemorrhagic tendency occurs in 33 per cent. of cases of myelomatosis (Sapper, Turner, and Moscovitz, 1953), and in most of those with retinal involvement, bleeding elsewhere in the body is present. Although investigation of this bleeding tendency has not been extensive, a frequent abnormality is an increase of serum proteins with a specific rise in the gamma globulin fraction. Waldenstr6m (1952) has indicated the role of hyperproteinaemia in myelomatosis and has shown that it encourages auto-agglutination of the blood. The development of vascular complications anywhere in the body may thus be compared with the sequence of events observed in the retina. First, the venous blood flow becomes sluggish, and this can be induced or aggravated by pressure on the eyeball (Foord, 1935). There is then occlusion of small veins and venules with retinal haemorrhages and ultimately thrombosis of the central retinal vein. Examples of each of these processes have been described in the literature.

Ophthalmological Complications of Multiple Myelomatosis