Can you help me find an explanation for the black spots on my mother-in-law's eyes as she neared death?
May 14, 2009 8:57 AM Subscribe
What might have caused black spots to form and grow on my mother-in-law's eyes as she was dying from pancreatic cancer and the inevitable infections that go along with cancer and its treatment? I'm hoping someone with a similar experience or someone in the medical field might be able to tell us something that the doctors here couldn't.
My mother-in-law passed away last week, nearly two years after being diagnosed with pancreatic cancer. She was strong and active through most of her treatment and continued to play tennis, travel overseas, and enjoy time with her five grandchildren. We all knew that we were on borrowed time and we made the most of our time with her. We did things as a family, said the things we needed to say to her, and listened to what she needed to say to us. We made sure that she knew that she was loved and would be missed, but that we were ready to let go when it was time for her to leave us.
Her condition deteriorated quickly last week and when she became non-responsive the decision was made (according to her wishes) to cease all treatment and medication other than pain management. My wife, brother-in-law, and father-in-law stayed at her bedside until she died two days later.
During those two days her mouth and eyes stayed open and slack, which we had been told to expect. Towards the end (I'm finally getting to my question -- sorry for the rambling, but this has been a little therapeutic for me) her eyes developed a number of small, black spots which grew and merged until they nearly covered her irises completely. We suspected dryness might be partly responsible, but lubricating eye drops had no effect. The nurses and doctors didn't have an explanation and they didn't seem inclined to look for an answer. I wasn't impressed with some of them to begin with and that certainly didn't help matters.
The appearance of her eyes was disturbing enough that my wife got to a point where she couldn't look at her mother's eyes any longer. For my wife, this has been one of the hardest parts of losing her mom. She feels like she wasn't "strong enough" at the end because she couldn't look in her mom's eyes. I know that this is something that she will deal with in time, and she has told me that she would probably be able to do that more easily if she had an explanation for what she saw. I have done a bit of googling and haven't found an answer, but some of the memories and experiences are still fresh and reading about the dying process is difficult right now, so I haven't gotten too deep.
One bit of additional information that may or may not be relevant: In the last weeks of her life, the doctors told us that she had a fungal infection in her abdomen. They suspect that her sudden decline may have been caused by the spread of that infection to her brain. We have wondered if that might have been responsible for what happened to her eyes as well, but that's just speculation on our part.
My mother-in-law passed away last week, nearly two years after being diagnosed with pancreatic cancer. She was strong and active through most of her treatment and continued to play tennis, travel overseas, and enjoy time with her five grandchildren. We all knew that we were on borrowed time and we made the most of our time with her. We did things as a family, said the things we needed to say to her, and listened to what she needed to say to us. We made sure that she knew that she was loved and would be missed, but that we were ready to let go when it was time for her to leave us.
Her condition deteriorated quickly last week and when she became non-responsive the decision was made (according to her wishes) to cease all treatment and medication other than pain management. My wife, brother-in-law, and father-in-law stayed at her bedside until she died two days later.
During those two days her mouth and eyes stayed open and slack, which we had been told to expect. Towards the end (I'm finally getting to my question -- sorry for the rambling, but this has been a little therapeutic for me) her eyes developed a number of small, black spots which grew and merged until they nearly covered her irises completely. We suspected dryness might be partly responsible, but lubricating eye drops had no effect. The nurses and doctors didn't have an explanation and they didn't seem inclined to look for an answer. I wasn't impressed with some of them to begin with and that certainly didn't help matters.
The appearance of her eyes was disturbing enough that my wife got to a point where she couldn't look at her mother's eyes any longer. For my wife, this has been one of the hardest parts of losing her mom. She feels like she wasn't "strong enough" at the end because she couldn't look in her mom's eyes. I know that this is something that she will deal with in time, and she has told me that she would probably be able to do that more easily if she had an explanation for what she saw. I have done a bit of googling and haven't found an answer, but some of the memories and experiences are still fresh and reading about the dying process is difficult right now, so I haven't gotten too deep.
One bit of additional information that may or may not be relevant: In the last weeks of her life, the doctors told us that she had a fungal infection in her abdomen. They suspect that her sudden decline may have been caused by the spread of that infection to her brain. We have wondered if that might have been responsible for what happened to her eyes as well, but that's just speculation on our part.
It sounds a lot like tache noire (or tache noire sclerotique or tache noire de la sclerotique) which is a commonly observed post-mortem artifact finding at autopsy. I've never heard of it developing prior to death, but I would not think it inconceivable that it would happen if the patient spent a prolonged period of time with the eyes open and unblinking, as it is thought to be a drying artifact. (If you google it, be aware that there is also a tick-bite related skin change with the same name and is totally unrelated). Google
posted by i_am_a_Jedi at 9:52 AM on May 14, 2009
posted by i_am_a_Jedi at 9:52 AM on May 14, 2009
Best answer: First off, I am sorry to hear about your mother-in-law's passing. Pancreatic cancer is a miserable diagnosis, and one that we (the oncology/drug-development community) have had a helluva time fighting.
Based on what you wrote, I'd bet the farm that it was probably disseminated fungus (fungal endophthalmitis) - possibly caused by Aspergillus fumigatus. Aspergillus is a not-uncommon opportunistic infection in immunocompromised patients (e.g., those getting chemotherapy). The fungus can spread through the blood. If it seeds the eye, it's possible to get fungal infiltrates. It could also be caused by Candida albicans (yeast).
It's likely not retinoblastoma. Retinoblastoma is typically a cancer of early childhood, forms in the retina (thus the name) and causes leukocoria - an abnormal whitish reflection from the retina.
It could also be metastases from the tumor itself, although this appears to be very rare (see this case report).
posted by scblackman at 10:20 AM on May 14, 2009 [4 favorites]
Based on what you wrote, I'd bet the farm that it was probably disseminated fungus (fungal endophthalmitis) - possibly caused by Aspergillus fumigatus. Aspergillus is a not-uncommon opportunistic infection in immunocompromised patients (e.g., those getting chemotherapy). The fungus can spread through the blood. If it seeds the eye, it's possible to get fungal infiltrates. It could also be caused by Candida albicans (yeast).
It's likely not retinoblastoma. Retinoblastoma is typically a cancer of early childhood, forms in the retina (thus the name) and causes leukocoria - an abnormal whitish reflection from the retina.
It could also be metastases from the tumor itself, although this appears to be very rare (see this case report).
posted by scblackman at 10:20 AM on May 14, 2009 [4 favorites]
I'm sorry for your loss. Cancer is a brutal disease for the patient, their loved one and their care providers.
While I can't directly answer your question, I'll add this. Perhaps the doctors didn't seem inclined to investigate simply because there was no positive outcome. If they'd have tested and investigated, they still could not have treated it because of the patient directive. Testing to identify the cause would not have improved those 2 days. (However, I'm an info junkie and I'd be looking for answers too.)
It may provide some comfort to think it wasn't a lack of caring that prompted the care providers' response. It was driven by a desire to preserve whatever peace and dignity can be possible in an impossible situation.
posted by 26.2 at 11:26 AM on May 14, 2009 [5 favorites]
While I can't directly answer your question, I'll add this. Perhaps the doctors didn't seem inclined to investigate simply because there was no positive outcome. If they'd have tested and investigated, they still could not have treated it because of the patient directive. Testing to identify the cause would not have improved those 2 days. (However, I'm an info junkie and I'd be looking for answers too.)
It may provide some comfort to think it wasn't a lack of caring that prompted the care providers' response. It was driven by a desire to preserve whatever peace and dignity can be possible in an impossible situation.
posted by 26.2 at 11:26 AM on May 14, 2009 [5 favorites]
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I am very sorry for your loss and the lack of an explanation for such a visually distressing phenomenon. Please be warned that if you google images- they are disturbing, many of children.
posted by hellboundforcheddar at 9:32 AM on May 14, 2009