Ocular Manifestations Of Systemic Disease

Your Eyes Are Windows To Way More Than Your Soul

Written by: Alan Mendelsohn, M.D., F.A.C.S.

When patients have systemic diseases, their primary care doctors will often send
them to the eye doctor to check for any eye damage that may have resulted from
their illnesses. However, every day, while performing routine, thorough eye exams,
eye doctors diagnose serious, systemic illnesses that patients were previously
unaware of.

Diabetes is one of the most common illnesses that can be identified on routine eye
screenings. Diabetes is a disease that affects blood vessels throughout the body, with
the vessels in the kidneys and eyes being particularly hard hit. Blood vessels in a
structure of the eye called the retina are especially predisposed to leaking blood or
fluid, providing a “red flag” that can be readily seen on eye examination and signal to
eye doctors that a patient likely has systemic diabetes and requires further testing
and treatment.

In addition, some patients may have other endocrinologic diseases such as thyroid
disease that ophthalmologists can identify immediately. In a particular type of
thyroid disease, called Graves Disease, some patients experience a symptom called
exopthalmos – or a swelling of the eyeball that can sometimes protrude out of the
eye socket. Identifying thyroid diseases early can save patients’ vision, but can also
save lives, as some of these disorders can be fatal if not identified and treated.

Rheumatoid arthritis, lupus, and multiple sclerosis (MS) are some autoimmune
conditions in which patients’ immune systems attack their own bodies. Often, one of
the first organs affected is the eye. Patients may come to the eye doctor with
symptoms ranging from temporary blindness to simple redness of the eye. In MS, in
particular, up to 20% of patients initially complain of a seemingly unusual set of
symptoms: sudden vision loss in only one eye, pain with eye movement, or double
vision. As a result, an ophthalmologist is the first physician to suspect a diagnosis of
MS. For all of these conditions, when the eye doctor performs a thorough exam, he
or she can diagnose the root cause of patients’ symptoms and quickly refer them to
specialist care for immediate treatment, which can slow or even halt the
progression of these devastating diseases.

Aside from pink eye, which we all know and love, many infectious diseases are often
first diagnosed at the eye doctor’s office, including Lyme Disease, Adenovirus, TB,
Herpes viruses, syphilis, and even HIV. While some of these diseases, such as
adenovirus, often resolve quickly and easily, others can have severe and lasting
impairments of the eyes and other organs if not treated quickly. Ensuring patients
are immediately started on appropriate antibiotics and/or other antimicrobial
treatments often protects not only patients, but also family members and close
contacts, preventing wide-spread outbreaks of these diseases.

Speaking of family members, ophthalmologists frequently catch illnesses in babies,
children, and even pregnant women that can prove to be life-saving diagnoses. In
pregnant women, preeclampsia can cause high blood pressure, which may only
present itself early in pregnancy if a doctor specifically looks for it. However, on
routine eye exam, symptoms of high blood pressure can appear, such as “nicked”-
appearing blood vessels. In a previously asymptomatic young woman, such findings
raise alarms and provide sufficient warning time for the patient to be aware of her
condition and begin treatment before it affects her or her baby. Without treatment,
preeclampsia can cause miscarriages, premature births, and placental anomalies for
the baby, but can also cause seizures and other severe side effects in the mom.
Caught early, these terrible consequences of preeclampsia can often be completely

In children, eye doctors may be the first to find evidence of chronic illnesses such as
sickle-cell anemia, retinoblastoma, or juvenile arthritis; infectious illnesses such as
CMV, rubella, or congenital syphilis; and even signs of trauma or abuse, such as
evidence of shaken-baby syndrome. These early warning signs allow doctors to
intervene quickly and save patients’ lives.

Perhaps even more surprisingly, eye physicians can diagnose cancers on routine eye
exams. Breast cancer affects 1 in 4 American women. Often, women may be
completely asymptomatic, but have severe, metastatic breast cancer.
Ophthalmologists may see metastases, or tumors that have grown beyond the
original tumor’s location, in a structure of the eye located behind the retina, called
the choroid. If an eye doctor finds evidence of breast cancer, they rapidly refer
patients to oncologists so treatment can begin as soon as possible. Other systemic
cancers, including colon cancer, lung cancer, kidney cancer, and even melanoma can
often be first diagnosed on routine eye exams.

Some say that the eyes are the window to the soul. Well, they are certainly a window
to the brain, and eye doctors often find signs of diseases and cancers in the brain
before anyone else is aware of them. Because the brain is tightly packed within the
skull, anything else located in the skull, such as blood, fluid, or even tumors,
increases the pressure in the small space. Any structure that can be moved
outwards, away from the pressure, does, including the nerve to the eyes. Swelling of
the optic nerve is readily apparent on eye exams, and immediately tells eye
physicians that there’s a serious problem. Because of this series of events, most
ophthalmologists diagnose brain tumors multiple times every year. While some
patients with brain tumors experience symptoms ranging from headaches to
impaired color vision or altered eye movements, most people with brain tumors are
entirely asymptomatic, and going for routine eye exams saves their lives.

People typically see their eye doctors hoping to improve their eyesight. What they
often don’t realize is that over 200 major, systemic diseases have eye involvement
as part of the disease course. Ophthalmologists are positioned perfectly to be able to
identify these illnesses before anyone else and get patients to appropriate treatment
before symptoms develop or progress. Routine eye examinations definitely help
preserve and improve vision, but more importantly, they often save lives.


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