Medical Explainer

Doctors find that the 'boy with bleeding eyes' has cancer

A four-year-old boy in Assam has a rare symptom of leukemia that caused his eyes to bleed.

On August 12, four-year-old Sagar Dorji got the internet's attention. Dorji was the subject of an online fundraising campaign titled "boy with bleeding eyes pleads for help", The campaign said that the boy, whose parents are daily wage labourers, had a "mysterious condition [in which] his eyes started to pop out partially and bleed intermittently". The campaign succeeded in collecting Rs 3.66 lakhs for Dorji's treatment that helped pay for a surgery that helped the child even though he has lost vision in both eyes.

The story of Dorji's mysterious condition was was reported in newspapers in India and abroad. But what really caused his eyes to bleed?

Three months ago Dorji’s parents Pratim and Kusum started noticing his blood shot eyes. They suspected that he had an eye allergy but his his condition worsened with blood oozing out of his eyes. “We rushed him to the hospital," said the father Pratim Dorji. "The bleeding would not stop and his eyes appeared to be falling out of the eye socket.”

After a series of investigations at the Gauhati Medical College, doctors confirmed that the boy had acute myeloid leukemia or blood cancer. In acute myeloid leukemia, bone marrow in the body makes abnormal blood cells. These cancerous blood cells in Dorji’s body had travelled to his eyes. “The tumour cells were sitting in his eyes, pushing them out of the socket,” said Dr Damodar Das, registrar of the haematology department at Gauhati Medical College. “The bleeding of the eye was a symptom of the cancer, which we detected immediately.”

The poverty trap

Dorji’s parents live in Lakhimpur in Assam. His father Pratim's work as a labourer earns him around Rs 200 a day, on the days he has a job. When doctors at the Gauhati Medical College told the Dorji family that their son has cancer, they were reluctant to accept the diagnosis – a result, the doctors suspect, of their poverty.

According to the doctors, only one of Dorji's eyes was affected in June. “We were treating the cancer and his eye,” said Das. “Within a week of treatment, the family decided to go home. They said they did not have any money to continue attending to their child.”

Although Gauhati Medical College was treating Dorji for free, his parents could not afford to stop their work and stay with him at the hospital.

“In June, the deterioration of the eyesight had just begun," continued Das. "We could have arrested the damage but only if he could be kept admitted. The hospital can take care of the treatment expenses but the patient’s relatives have to take care of themselves.”

In August, when the family rushed Dorji to the hospital again, doctors found that the cancer cells had damaged his eyesight and now, the doctors fear, cannot be restored.

Rare, but not mysterious

Following news reports, Dorji was referred to Narayan Health City in Bengaluru where doctors started him on chemotherapy. “It is very unusual to see [acute myeloid leukemia] spreading to the eyes,” said Dr Sunil Bhat, head paedeiatric haematology at the hospital. “In all the cases we have seen, this is the most advanced. We have never seen such an extensive damage to both the eyes.”

Dorji had what doctors call “chloroma” a manifestation of acute myeloid leukemia where the cancer cells form a tumor outside the bone marrow. In Dorji’s case, the chloroma was formed in the eye, which caused the pushed the eyes out of their sockets and caused bleeding, the doctor explained.

Dorji now relies on a bone marrow transplant to treat the leukemia. Bhat who specialises in such transplants said that his team is working to find Dorji a match, which they hope to find within Dorji's family. "A sibling is most likely to have a matching HLA.“We are hoping that his sibling’s is a match. Then, we can go ahead with the transplant,” said Bhat.

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