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Systemic Disease & Your Eyes

I often get asked how different diseases of the body affect the eyes and why it’s important to

have annual comprehensive eye exams even if you have perfect vision. So I thought I would

talk about the more common systemic diseases and their impact on the eyes.

Hypertension (High Blood Pressure) affects over 50 million Americans but few people know

how it can affect the eyes. When your blood pressure becomes elevated, your retina (located

in the back of your eyes) can start to develop small flame-shaped hemorrhages. If left

untreated, it can do enough damage to cause strokes and aneurysms in the blood vessels of the retina which can lead to loss of vision or even blindness. This is known as Hypertensive

Retinopathy and it is only visible by dilating the eyes or taking a wide-angle digital scan of the

back of the eye. The severity of damage to the retina is a good indicator of how poorly

controlled a patient’s blood pressure has been recently.

Hyperlipidemia (High Cholesterol) cause plaques to form in the tiny blood vessels in the

back of the eye causing ischemia (reduced blood flow). If those blood vessels get completely

blocked, the retinal tissue which is served by that vessel can die off and the vision lost to that

section of your eye. Sometimes the blockage can cause a large bleed in the retina from a

rupture of the vessel wall further damaging the surrounding tissue. Occasionally, the blockage

is behind the eye in the optic nerve and can also cause sudden and potentially permanent

vision loss as well. It is important to get your cholesterol checked annually if you are in an at

risk category (family history, poor eating habits, previous abnormal blood work results, etc).

Eye doctors will check the health of your retina either by dilation or a newer method using a

wide-field digital photo scan. Sometimes the cornea (front window of the eye) can also develop

white rings called “arcus” in the periphery which people often confuse with cataracts. So if you

start to notice a slow greying out of the color in your eyes, have it checked out.

Retinal damage from Diabetes is the leading cause of preventable

blindness worldwide. Diabetic Retinopathy is usually present in nearly 100% of all Type 1

diabetics and around 65% of Type 2 diabetics. The early stages usually present with what are

called “dot-blot” hemorrhages and are often accompanied by fluid and protein leaking out of

the blood vessels. Eye doctors may also notice unusually large fluctuations in your vision

prescription in a short amount of time. In the more advanced stages of damage, new leaky

blood vessels start to grow and can detach the retina causing blindness. Swelling of the macula

(the central retina) is what causes the greatest vision loss to your central vision when the

diabetes is severe. It swelling of the layers of the retina causing the vision to be blurred. More

severe cases of diabetic retinopathy are treated with lasers to try to limit the new blood vessels

formation and reduce the leakage, but long term only strict diabetic control of your blood sugar

will be able to keep your vision functional. Your eye doctor works closely with your

endocrinologist to make sure that each one knows what’s going on with the other in terms of

control, lab work, and retinal findings. So test your sugar often, and keep it controlled.

So the moral of the story is that diseases of the body can directly affect the health of your eyes so it's important to let your eye doctor check the health of your eyes every year. The best way to screen for a lot of damage is a digital scan of the back of the eye, such as an Optomap photo.