Bilateral simultaneous central retinal vein occlusion presenting as initial manifestation of multiple myeloma

A fifty years old male with a medical history of diabetes mellitus presented with complaints of sudden painless bilateral vision loss since 2 weeks. Ophthalmic examination showed visual acuity in both eyes were counting finger 2 meters. Intraocular pressure and anterior segment examination findings in both eyes were normal. Fundoscopy revealed bilateral central retinal vein occlusion (CRVO). Haematological and radiological investigations confirmed diagnosis of multiple myeloma and ocular manifestation in the form of bilateral simultaneous CRVO was the first presentation of multiple myeloma. This patient had a double hyper viscosity insult with severe diabetes mellitus and multiple myeloma. Since abnormal blood viscosity plays a role in the causation of bilateral CRVO, systemic investigation for underlying hyperviscosity syndromes including blood dyscrasias such as multiple myeloma is warranted.