The Eyes Have It

A Thorough Vision Exam Can Uncover Many Diseases And Conditions



Many non-ocular ailments can be detected with an eye exam

Your eyes not only are the window to your soul, but also the window to your body’s overall health. A thorough eye exam can reveal undiagnosed diseases and conditions such as high blood pressure, thyroid disease, multiple sclerosis and diabetes.
“The eye is one of the few parts of the body where you can actually see living blood vessels,” says ophthalmologist Dr. Mark A. Pavilack of Tidewater Eye Centers, with locations in Chesapeake, Portsmouth and Virginia Beach. “When we look at those blood vessels, we can see changes that might be caused by conditions such as diabetes or high blood pressure. We may see cholesterol crystals visible in the blood vessels of the eyes. We might detect those diseases before the person even knows he or she has them. The eye exam offers a special kind of window into the internal body.”

A major worsening in vision can signal diabetes, says ophthalmologist Dr. Samuel N. Garrett of Virginia Beach Eye Center. “The patients can’t see with their glasses. They were a little nearsighted; now they’re a lot nearsighted. We have the patient get his or her blood sugar checked and lo and behold—the patent has diabetes.”

In addition, a staring, bug-eyed look can signal thyroid eye disease, also called Grave’s disease, Garrett says. The eyes can be treated with lubricating drops; and the patient can be treated systemically with oral steroids, radiation therapy or surgery for a return to normal appearance, he says.

A number of metabolic conditions, many of which are rare, reveal themselves in deposits of waste products on the cornea, Pavilack says. These include Wilson’s disease (which causes too much copper to accumulate in the body) and Hurler syndrome (in which the body can not break down long chains of sugar molecules). Changes in the eye also can point to Lupus, Rheumatoid Arthritis and Crohn’s disease, he says.

Other diseases, including MS, cause inflammation in the optic nerve, while inflammation inside the eye can point to Lyme disease or to sexually transmitted diseases, he says.

Numerous other issues show up via the eyes. Loss of vision also can signal a brain tumor, Pavilack says. A hemorrhage in the retina can signal untreated high blood pressure, Garrett says. Light sensitivity can indicate other problems, Pavilack says. A case of what might seem to be conjunctivitis, commonly called pink eye, that doesn’t get better with treatment in a week could indicate more serious health problems, Pavilack says.

A brain tumor can cause both eyes to lose vision at the same time, with both eyes losing sight on the left or right side, Pavilack says. “Think about the eye as an extension of the brain,” he says. “The eye often functions as an extension of the central nervous system. About one third of the brain’s input and output involves the vision system.”

On the flip side, if you already know you have a health problem elsewhere in your body, an eye exam may be called for to make sure that condition isn’t adversely affecting your eyes, Garrett says. “These patients already know they have diabetes, high blood pressure, high cholesterol, Lupus, Rheumatoid Arthritis,” Garrett says. “The patient says ‘I have diabetes, and my doctor says I need to come see you.’ The patient may have diabetic retinopathy (where the blood vessels swell and leak fluid—a major cause of blindness) and it’s important that we see them and begin treatment. In these cases, the patient is being sent to check for ophthalmologic manifestations for diseases they already have.”

Your eye doctor can help with treating these diseases. Systemic auto-immune diseases such as Rheumatoid Arthritis and Lupus with ophthalmic manifestations such as dry eye and inflammation can be treated with topical lubricants, steroids and other anti-inflammatory medicines. Inflammation caused by Rheumatoid Arthritis can be treated with anti-inflammatory eye drops, Garrett says. The dry eyes caused by Lupus can be treated with steroids, he says.

Another issue to keep in mind is that sometimes the medication used to treat certain conditions can actually cause eye problems. For example, “People with rheumatoid arthritis take hydroxychloroquine to reduce the symptoms of RA,” Garrett says. “But the medication can cause vision problems and lesions within the central part of the retina called the macula. People who take this medication should get their eyes checked every year including special testing to detect toxicity.”

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