Retina specialist Nimesh Patel, MD, explains the how certain eye symptoms might provide clues to what is happening in other systems and organs in the body.
If you want to get a holistic view of your health, your eyes might be the first place to look.
Signs of heart disease, diabetes, autoimmune conditions or even cancer sometimes first appear in the eye, particularly in the retina. The retina is a layer of cells lining the eye’s back wall. It gets supplied with blood and oxygen through the retinal blood vessels.
Through a comprehensive eye exam and imaging techniques like microscopy and optical coherence tomography (OCT), ophthalmologists might see changes in these vessels that provide clues to something amiss elsewhere in the body.
“The back of the eye provides doctors a glimpse into very small blood vessels in the body. If there is systemic disease, these are some of the blood vessels that become affected first,” Dr. Nimesh Patel, a member of the Retina Service at Mass Eye and Ear, explained to Focus. “The eyes are also one of the first organs that become symptomatic. Some diseases can cause small changes in organs such as your kidneys and liver, and you won’t feel a problem. But a small change in the retina might cause blurry vision.”
Here are some common diseases that cause eye symptoms:
Cardiovascular and metabolic diseases
Heart disease and metabolic syndromes like diabetes are among the most common conditions ophthalmologists spot in patients’ eyes.
High blood pressure, or hypertension, causes swelling of the eye’s optic nerve, which can affect vision. It can also cause small hemorrhages in the retina, and yellow fluid leaks out of the retina’s blood vessels.
A blood clot in the retinal vessels could be a sign of a cardiovascular problem, and be seen upon examination or through a follow-up test that looks at how blood flows in to the retina, called fluorescein angiography. These blood clots can be a sign that clots are being formed elsewhere in the body including the brain (stroke) or the heart. If these are seen by the Ophthalmologist, patients are referred to the hospital for immediate further medical work up.
Diabetes is another condition that affects the small blood vessels of the retina, making them unstable. This can lead to fluid leaking and also cause the formation of new, abnormal blood vessels. This is called diabetic retinopathy. Patients with diabetic retinopathy might experience changes in vision such as blurred vision, fading of color, difficulty seeing at night, blank or dark areas in the vision field, and more floaters, according to the American Academy of Ophthalmology.
Dr. Patel encourages people with heart disease and diabetes risks to get their eyes examined annually to ensure these conditions don’t cause permanent vision damage.
“Sometimes the signs of disease are not visually significant. We might have some people come in with high blood pressure or diabetes, but not too many visual symptoms,” said Dr. Patel. “But upon closer examination, we see that they have pretty significant, untreated eye damage that one day may affect their vision.”
Autoimmune and inflammatory conditions
Certain autoimmune diseases that cause inflammation in different areas of the body can also present as inflammation in the eye. These diseases include lupus, rheumatoid arthritis, sarcoidosis and Behcet’s syndrome, among others. This resulting eye inflammation is called uveitis. Uveitis is a swelling that if untreated can cause vision loss through damaging the tissues in the central layer of the eye. Typical symptom of uveitis include eye pain, redness, blurred vision, light sensitivity and increased floaters.
An ophthalmologist might consult with a patient’s rheumatologist to make sure their treatment is also managing these eye symptoms in order to prevent further vision damage.
In other cases, these eye symptoms are the first presentations of an autoimmune disease.
“There have been cases where we ask patients questions after spotting these signs , and they recall some joint pain and other symptoms in the past which they did not realize were associated with an autoimmune condition,” Dr. Patel pointed out.
Graves’ disease is another autoimmune disease that shows up in the eyes. It can lead to what’s called graves’ ophthalmopathy, or thyroid eye disease, in about 30 percent of patients. A person’s eyes may bulge and fall forward in front of their lids and appear red and watery. This can be treated by steroids, surgery or newer medications for more severe cases.
Cancers that have metastasized
The eye is also one of the first places a doctor might see that a cancer has spread, or metastasized.
A typical situation, according to Dr. Patel, occurs when a person has an early-stage cancer or is in remission, and they see an ophthalmologist with a complaint like blurred vision, only to learn a new cancer has formed. The cancer may have first spread elsewhere in the body, such as the liver or kidneys, but those organs can’t be seen in an exam, whereas the eyes can. This more commonly occurs for melanoma spreading to the back of the eye, but also for other cancers like breast cancer.
Neurological diseases may present as abnormal eye movements or optic neuritis, which can cause pain and/or temporary vision loss. The most common neurological condition that causes optic neuritis is multiple sclerosis. In some cases, optic neuritis might occur with other symptoms elsewhere such as weakness in the arms and legs. This might signify a disease flare. In other cases, optic neuritis might be the first sign of a neurological condition.
An MRI test ordered by an ophthalmologist or neuro-ophthalmologist can confirm an optic neuritis diagnosis.
Keeping up with regular checkups
In order to best prevent or catch and treat a disease that causes issues with the eyes, people should keep up with their regular medical appointments, according to Dr. Patel. This includes annual primary care visits and vision exams with an ophthalmologist or optometrist.
It’s especially important for those with these risk factors and diseases to keep up with their vision exams. Primary eye care providers can perform a dilated exam and refer to a specialist, if there’s need for further testing and treatment.
“Sometimes patients can experience blurry vision and think, ‘I just need glasses,’ and unfortunately wait for months to be checked. They might not know that vision changes can have many causes including some associated with systemic disease and overall health. ,” said Dr. Patel. “The take-home message is that it’s important to stay on top of your appointments and screenings and to make sure to an eye doctor as soon as you are having symptoms”
About the Expert
Nimesh Patel, MD, is a member of the Retina Service at Mass Eye and Ear. He specializes in the medical and surgical treatment of vitreoretinal diseases. Dr. Patel has expertise working with both adult and pediatric patients. He sees patients at our Main Campus in Boston.