Diseases Detected Through The Eye
The eyes are susceptible to numerous conditions and can be a clear indicator of
many diseases. In this article, Roshni Patel, BSc (Hons) MCOptom, looks into some of the many conditions an eye examination can detect. From
auto-immune and inflammatory conditions to cancerous diseases and neurological
problems, Roshni reveals how optometrists can spot signs and symptoms that can
help save lives and protect your health.
Diabetes is one of the more commonly known diseases that can be detected through
the eye. Optometrists are able to identify the condition when seeing bleeding on
the back of the eye through diabetic retinopathy, which is a result of high
blood sugar. Diabetes is also linked to cataracts, glaucoma (specifically
primary open-angle glaucoma), and retinal detachments, as well as rare
conditions such as a 3rd nerve palsy.
Hypertension, a condition in which blood pressure is consistently elevated, is
normally detected by a GP - but indicators can also be seen during a routine eye
exam if hypertensive retinopathy develops, as shown in the following case study:
“I had a middle-aged lady that came in for a routine contact lens check and eye
exam. When assessing the back of her eyes, the patient had extensive
haemorrhaging on the retinae, indicative of advanced hypertensive retinopathy.
Luckily there was a walk-in centre nearby; I called them to get her blood
pressure checked and they were happy to see her. I remember being called back by
a panicked GP telling me the BP results. She asked me my findings and we agreed
– ‘call an ambulance’. With BP that high, it was very likely that this patient
was close to a stroke. She was kept in the hospital for a while.“
- Roshni Patel, BSc (Hons) MCOptom
Accordingly, signs of hypertension that optometrists look for in the eye
include any arteriolar constriction, vascular wall changes, arteriovenous
nipping, haemorrhaging (particularly ‘flame’ shaped), yellow hard exudates, or
optic disc oedema.
Indications of high cholesterol that may develop around the eyes include
xanthelasma, which are deposits of fat beneath the skin on the eyelids, or an
arcus, which is a white ring around the
outer edge of the cornea. Both may occur without high cholesterol but should
prompt consultation with a GP. More threatening is vision loss from retinal
artery occlusion, which generally appears as a painless loss of vision in one
eye, and should be dealt with directly and urgently alongside an investigation
into cholesterol levels.
An overactive thyroid produces an increase in thyroid hormones, and can be
caused by a number of conditions, including the autoimmune condition, Graves’
disease. This can lead to thyroid eye disease, also known as Graves' orbitopathy,
which sees the muscles and soft tissues in and around your eye socket swell.
Your eyes may also become dry, and you may experience redness or pain on eye
movement, as well as double vision. The condition can also cause the eyes to
The inflammation that affects joints can also affect the eye. Symptoms include
dry eyes, blurry vision, scleritis (a very serious condition, which causes
redness, light sensitivity and pain), and episcleritis, which is limited to the
episclera and less serious: both can be identified through standard eye tests.
Sjögren’s disease affects areas of the body that produce fluids and, therefore,
can present in the eyes as dryness (aqueous deficiency); it may also be linked
with other autoimmune diseases such as lupus or rheumatoid arthritis.
Sarcoidosis, Ulcerative Colitis, and Ankylosing Spondylitis
Inflammatory conditions can present as uveitis, namely anterior, in the form of
iritis, in which the eye may become very painful, red, and sensitive to light.
Uveitis is a serious condition and needs prompt medical attention.
Sarcoidosis may also entail episcleritis/scleritis, eyelid abnormalities,
conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and
orbital inflammation as it can affect all structures within the eye.
Tumours can cause swelling of the optic nerve at the back of the eye (papilloedema)
- due to raised intracranial pressure individuals can experience a loss in
visual field (the type will vary based on the location of the tumour), extreme
headaches (worse on waking), and double vision.
Multiple sclerosis may be the underlying cause of optic neuritis (inflammation
of the optic nerve), though not all cases of optic neuritis lead to MS. An
example follows in which a patient was diagnosed with optic neuritis, allowing
investigation into whether she had MS to start as early as possible:
“A young lady came in for a second opinion after being seen elsewhere, due to a
sudden onset of ‘patchy’ vision and dull pain in one eye and told it was down to
“When I assessed her vision in the affected eye, she had minimal perception, and
could only register light. This was not indicative of dry eyes and noting her
gender, age and suspicious pupil reaction to light I had an inkling that it may
be optic neuritis.
“On assessing the back of her eyes, especially her optic nerves, everything
appeared normal. This is quite common in ‘retrobulbar neuritis’ where the
swelling/inflammation occurs behind the optic nerve head. We took photos of the
back of the eye, allowing me to analyse the eye in more detail, and I noticed a
very subtle area of swelling.
"There was no point in performing a visual field assessment as her affected eye
only had light perception, but patients with optic neuritis often have a
distinctive visual field loss. I referred her to Neurology, and she was
confirmed as having optic neuritis."
- Roshni Patel, BSc (Hons) MCOptom
Other symptoms that may be reported by those with MS may include double
vision, impaired colour vision, and pain or difficulty moving the eye.
Pancoast Tumour in the Lungs
Pancoast tumours are cancers in the top part of the lungs and are relatively
rare with just 5% of cases of lung cancer being a result of a pancoast tumour.
Patients can experience symptoms such as severe pain in the shoulder and arm as
well as weakness in the hand on the side of your body that is affected. Another
sign of this cancer is Horner’s syndrome, which is a combination of signs and
symptoms that can occur in a patient. It typically includes having a smaller
pupil, drooping eyelid, and reduced sweating on the affected side of the face.
If of sudden onset or associated with other signs and symptoms, patients need to
be seen by a doctor immediately.
Roshni provides a case study on a patient suffering from a pancoast tumour:
“I was taught at university to always assess a patient when they walk into
practice (i.e. do they have mobility issues, have they got a head tilt etc to
get a very high-level idea about general health and potential eye conditions to
look out for), so when this elderly gentleman sat down in my chair mentioning
his prolonged shoulder pain in passing, I instantly thought arthritis and dry
eye. However, that was not the case, unfortunately.
“His main reason for attending was because he suddenly noticed the pupil in 1
eye was a lot smaller than the other.
“After assessing his pupils in different light settings, I knew it was Horner’s
syndrome. He also had a very subtle dropping of his eyelid of the affected eye.
Horner’s syndrome can occur for many reasons but in his case, as confirmed by
the hospital, it was down to a tumour in his lung – Pancoast tumour.”
- Roshni Patel, BSc (Hons) MCOptom
With the above symptoms in mind, it’s important to recognise that the eye can be
an early indicator of disease across not just vision-related areas, but also the
rest of the body.
Optometrists need to be constantly aware of how a sign or symptom may be as a
result of wider disease and offer appropriate and timely management.
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