The old saying is that “the eyes are the windows to the soul,” but it is also true that key ophthalmological findings can reveal a lot about a person’s physical health as well. Many common eye complaints are usually symptoms of benign disorders but can occasionally indicate a more serious eye problem or, in some cases, a systemic disorder.
Dry Eyes are one of the most common complaints and this condition can have a variety of causes. Decreased tear production by the lacrimal glands can be a result of aging, hormonal changes or some autoimmune diseases, for example, primary lupus, Sjögren’s syndrome, or rheumatoid arthritis. Also important to keep in mind is that common medications may decrease tear production including antihistamines, antidepressants, beta-blockers, and oral contraceptives.
Floaters or tiny specks or spots seen in the visual field are another common complaint. The perception of floaters, or myodesopsia, results most commonly from age related degenerative changes to the vitreous humor. Unlike the aqueous humor which is continuously replenished, the vitreous humor is a quiescent tissue remaining stable over a lifetime. For this reason, if blood or other residual inflammatory cells enter the vitreous after an injury or infection, they will stay there and appear as floaters, especially in bright sunlight. While floaters may be irritating, they are harmless. However, other similar changes in the visual field may warrant further investigation or intervention. Flashes of light or sudden change in the type and number of floaters perceived can indicate a retinal tear, or worse, retinal detachment. Retinal detachment is a true ophthalmologic emergency and is ideally diagnosed and treated before the central macular area of the retina detaches.
Deceased visual acuity or nearsightedness is often an inevitable part of aging but systemic disorders can cause visual symptoms that mimic age related changes and for this reason annual vision and retinal exams are important. The slow onset of blurry vision for both close and distant objects not corrected by eyeglasses can be a symptom induced by chronic hyperglycemia, as in diabetics or even the chronic myeloproliferative neoplasm polycythemia vera.
Changes in the visual field that appear along with migraine headaches can include transient visual loss in one or both eyes. When such changes are a side effect of migraine they are typically closely associated with the headache and disappear when the migraine subsides. As in the case of a retinal tear, sudden changes in the visual field, not associated with migraine, indicates the need for an emergent work-up. Transient vision loss can involve all or part of the visual field and range from mild blurring or haziness to occlusive darkness. Amaurosis fugax is the classically thought of transient loss of vision historically described as the descending of a curtain over one eye. Such a presenting symptom or loss of vision in small paranasal, central, paracentral or temporal areas are strongly suggestive of ocular ischemia. It can also indicate cerebral ischemia in the form of a transient ischemic attack, especially in the setting of carotid artery disease.
Sudden loss of vision can also occur in the setting of Giant Cell arteritis which usually begins as a severe headache, temporal tenderness or jaw claudication. Sudden vision loss may occur within a few days or weeks of the first symptoms and can usually be prevented with early diagnosis and treatment. Clearly this is not an exhaustive list of the myriad of visual symptoms related to systemic disease, rather some things to keep in mind and perhaps mention to older patients who might not come in to have eye symptoms or visual changes evaluated in a timely manner.
By Jenny Wheeler, Staff Writer