Ancient proverbs say that “the eye is a mirror into the soul”, but is it also a mirror reflecting the state of your health? Many diseases can be diagnosed with a simple eye exam. As a healthcare provider, you must know what they are and how to identify them.
Although to formally diagnose hyperlipidemia, you must simply test a patient’s blood cholesterol levels, changes in the eye can alert patients and providers to the possibility of elevated lipid levels. Xanthoma, a skin condition where fats build up under the skin especially around the eye point to an increase in cholesterol levels. In patients presenting with Xanthoma, a lipid panel should certainly be drawn to rule-out hyperlipidemia.
2. Sickle Cell Anemia
Ophthalmic changes associated with sickle cell disease occur as a result of vascular occlusion. They appear as dark red intravascular spots on exam of the optic disk. They are asymptomatic and do not result in visual impairment. These changes can also occur with other disease processes such as diabetes and therefore are not always an indication of sickle cell disease.
Diabetes is the leading cause of blindness in adults ages 20 to 74 and it is therefore imperative that you urge your diabetic patients to receive routine eye exams. Diabetes can result in diabetic retinopathy (vascular damage to the eyes), cataracts and glaucoma. In the earliest state of retinopathy, a patient often does not experience any symptoms. Fundascopic eye exam will reveal ‘cotton-wool spots’, small areas of yellowish-white discoloration. If you notice this finding, it is important to test your patient for diabetes if they are not already diagnosed and have them follow up with an ophthalmologist.
4. Colon Polyps (Gardner Syndrome)
Gardner Syndrome is a hereditary condition resulting in formation of colon polyps and other lesions such as epidermoid cysts. Although most lesions caused by this disease are benign, colon polyps can lead to colon cancer in these individuals. In relation to the eye, patients with Gardner Syndrome have hypertrophy of the retinal pigment epithelium. This condition does not affect vision but can be used to aid in diagnosis of Gardner Syndrome. On ophthalmic exam, pigmented lesions will be present. In patients with these findings, colonoscopy screening should be recommended.
In patients presenting with iritis who also have chronic back pain, spondyloarthritis should be considered. Iritis presents as painful inflammation of the eye including eye pain, redness and blurred vision. On slit lamp exam, you will see characteristic cells and flare (protein particles). Up to 40 percent of individuals with spondyloarthritis will experience at least one episode of iritis. Early detection of this disease leads to improved outcomes. If you suspect spondyloarthritis in a patient, they should be referred to a rheumatologist for further evaluation.
Jaundice, yellowing of the eyes and skin, can be caused by a host of medical conditions. This yellowing occurs as a result of excess bilirubin, a byproduct of old red blood cells. In patients presenting with jaundice, you should consider diagnoses involving the liver, gallbladder or pancreas. You should check a bilirubin level and consider ordering liver function tests, a hepatitis panel, cholesterol levels and abdominal ultrasound or CT to help determine the pathology causing jaundice in your patient.
I will be the first to admit, my eye exam skills are lacking. In patients with conditions such as diabetes predisposing them to ophthalmologic diseases, you should refer them to an ophthalmologist for routine eye exams. Patients presenting with other ocular symptoms where you are unclear of the diagnosis as well as patients with abnormal eye exam findings should be referred to an ophthalmologist for further evaluation and treatment.