Eyes Are the Windows to…Your Health?

There’s an old adage that “the eyes are the windows to the soul,” but I also believe that eyes are windows into one’s overall physical health. A thorough eye exam reveals much important information and may also give the first clues of underlying medical problems not previously diagnosed.

There are many wonderful advances in the diagnosis and treatment of eye diseases. My grandmother and her sister went blind from glaucoma. My father had glaucoma but was successfully treated. I get monitored annually because genetics play a significant role in this disease and early intervention is always best.

Close Your Eyes and Sleep

What most people don’t know is the essential role the eye plays in synchronizing our circadian (24-hour biological cycle) rhythms. Photoreceptive cells in the retina absorb sunlight and send messages to a part of the brain that regulates our internal clock. These cells stimulate the release of cortisol in the morning and melatonin in the evening.  Melatonin is believed to have many health benefits. Studies have shown that people with low levels of melatonin have a higher incidence of illnesses, including cancers, diabetes and heart disease.

As the eyes age, there is yellowing of the lens and narrowing of the pupil, allowing for less light to get through the lens which, in turn, affects normal circadian rhythms.

An ophthalmologic exam can reveal findings indicative of systemic health issues, such as diabetes, cardiovascular disease, hypertension, a myriad of connective tissue disorders (e.g. lupus, rheumatoid arthritis, vasculitides), infections, including HIV/AIDS, and cancers.

What Your Eyes Say about Diabetes

Diabetes is the leading cause of acquired blindness in working-age people in the U.S. The longer the duration of diabetes, the more likely you are to develop retinopathy (disease of the retina).

Some retinopathies can be diagnosed by lipids (fats) in the nerve fiber layer of the retina causing occluded or leaky capillaries and hemorrhages in the nerve fiber layer due to bleeding in the retina. Blocked blood supply to the retina can show up as “cotton wool spots” on an exam.

Other retinopathies, especially in advanced stages, can cause hemorrhages that could lead to retinal detachment.

What Your Eyes Say about High Blood Pressure

Hypertension (high blood pressure) may cause chronic changes in the eye, known as arteriolar sclerosis. Upon examination of this condition, one may see changes of the retinal artery in what appears to look like “copper or silver wiring.” In acute hypertensive crises, there may be lipid deposits in the nerve fiber layer, “cotton wool spots,” hemorrhages in the nerve fiber layer, and sometimes a whitish swelling of the retina. In malignant hypertension, swelling occurs where the optic nerve meets the eye.

What Your Eyes Say about Autoimmune Diseases

Grave’s disease is an autoimmune disease of the thyroid. Common features include: upper eyelid retraction with the upper lid lagging when you look downward; thyroid “stare”; corneal exposure ranging from mild dry eyes to serious exposure causing corneal ulcers; and optic nerve compression, caused by the enlarged muscles surrounding the eye.

Many autoimmune conditions are associated with eye manifestations, such as frequent dry eye and overall inflammation.

What Your Eyes Say about Cancer

A primary cancer of the eye is rare, but spread of cancers to the eye occurs in 5% of cancer patients at autopsy. These usually arise from breast or lung cancers. Lymphoma and leukemia may also occur in the eye with infiltration of the conjunctiva (mucus membranes between eye and eyelid) or optic nerve. Primary cancer of the eye, such as melanoma, may be completely asymptomatic (showing no overt symptoms) and can only be detected on a very thorough eye exam.

About 50% of people with AIDS will have “AIDS retinopathy,” cotton wool spots caused by small particles in the retinal vessels. No treatment is needed for this. A certain kind of retinal inflammation is the leading cause of blindness in AIDS patients, and the retina has a “pizza pie” appearance on exam due to hemorrhage and cell death.

I am often surprised at how few of my patients go for routine eye exams, if ever! As you can see, a good eye exam may reveal an abundance of information about overall health, and may even provide the first clues to medical conditions not otherwise noted. Certainly, if you note any changes in vision, you should go for an exam, and if there is a family history of glaucoma or other eye conditions, have your ophthalmologist follow this up on a regular basis.