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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

The Role of Eye Care in Managing Chronic Diseases

People often don't realize how strong is the link between eye health and systemic diseases. And how much eye exams affect early detection and on-time treatment. In this article we explore the role of eye care in managing chronic diseases, showing how eye symptoms can reveal hidden health problems.

Eye Health and Chronic Diseases

The eyes provide a non-invasive window into the body’s vascular and nervous systems. That's allowing ophthalmologists to notice signs of systemic diseases, even when the patient doesn't show any obvious symptoms.

The most common chronic diseases closely connected to the eyes are:

1. Diabetes

Diabetes mellitus is one of the most well-documented chronic diseases with an impact on eye health.

patient with Hypertension

Diabetic retinopathy, the most typical ocular issue caused by diabetes, occurs when high blood sugar levels damage the blood vessels in the retina. The damage causes swelling, leakage, and blockage of these vessels. It may result in vision loss if not treated timely.

Diabetic retinopathy is one of the leading causes of blindness in adults. During an eye exam, an eye doctor can spot microaneurysms, retinal hemorrhages, and macular edema, which may indicate the condition.

In addition to diabetic retinopathy, diabetes increases the risk of developing cataracts at a younger age and doubles the likelihood of developing glaucoma. With the increased risk for cataracts and glaucoma, routine eye examinations, at least 2 times a year, are critical for diabetics.

2. Hypertension

Hypertension, or high blood pressure, affects the entire vascular system. Meaning it can have devastating effects on the eyes and a condition known as hypertensive retinopathy.

patient with Hypertension

A person with the condition experiences changes in the retinal blood vessels. The changes include narrowing, arteriovenous crossing changes (AV nicking), and in severe cases, retinal hemorrhages, exudates, and papilledema.

Ophthalmologists can detect signs of hypertensive retinopathy, often before patients are aware of their hypertension. Early detection through retinal examination prompts further cardiovascular evaluation and management, potentially preventing severe complications like stroke and heart disease.

Chronic hypertension may also lead to central or branch retinal vein occlusions, where blood clots block veins in the retina, causing sudden vision loss. These chronic diseases are medical emergencies and require prompt treatment to restore vision and manage hypertension.

3. Autoimmune Diseases

Autoimmune chronic diseases like rheumatoid arthritis, lupus, and multiple sclerosis, have ocular manifestations.

Patients with rheumatoid arthritis may develop dry eye syndrome (keratoconjunctivitis sicca), uveitis, and scleritis. The reduced tear production from dry eyes may potentially damage the cornea. Scleritis, an inflammation of the sclera, entails severe pain and vision impairment. Uveitis, inflammation of the uvea, can lead to permanent vision loss if not treated on time.

Lupus can cause vascular changes in the retina (retinal vasculitis), leading to vision-threatening complications.

Optic neuritis and nystagmus may be an indication of multiple sclerosis (MS). Optic neuritis from MS may trigger sudden vision loss and pain with eye movement.

Eye care professionals are integral to the healthcare team in treating autoimmune diseases. They provide insights for a quicker diagnosis and better management of the underlying condition by identifying ocular manifestations even in early asymptomatic cases.

4. Thyroid Disorders

Thyroid disorders, particularly Graves’ disease, can lead to thyroid eye disease (TED), which causes inflammation and swelling in the eye muscles and fatty tissues behind the eyes. Symptoms of TED include bulging eyes (proptosis), double vision (diplopia), and vision loss due to optic nerve compression.

patient with Thyroid Disorders

Thyroid eye disease progresses through active and inactive phases. In the active phase, inflammation and swelling are common, requiring treatment with steroids or other immunosuppressive therapies. The inactive phase may require surgical intervention to correct proptosis and restore normal eye alignment.

Ophthalmologists can detect signs of thyroid eye disease during an eye exam and refer patients to an endocrinologist for further evaluation. Timely intervention can prevent severe outcomes and improve the quality of life for patients with chronic diseases.

5. Cardiovascular Diseases

Cardiovascular diseases, such as atherosclerosis and stroke, also have eye manifestations.

infographic atherosclerosis
Atherosclerosis: Arteries narrow and harden due to the buildup of fats, cholesterol, and other substances, leading to restricted blood flow to the heart.

Atherosclerosis can lead to retinal artery occlusions, causing sudden vision loss. The buildup of plaques in arteries may result in central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO). Both of which are ophthalmic emergencies. CRAO leads to sudden, painless vision loss, often described as a "black curtain" descending over vision. Immediate treatment is vital to restore blood flow and preserve vision.

Stroke can cause visual field defects and ocular motility disorders. The eye damage from a stroke can have severe implications on the patient's lifestyle and recovery.

During an eye exam, an ophthalmologist may detect signs of cardiovascular disease, prompting further evaluation by a cardiologist. The interdisciplinary approach ensures patients address both ocular and systemic health issues.

6. Neurodegenerative Disorders

Neurodegenerative chronic diseases, such as Parkinson’s disease and Alzheimer’s disease, can affect the eyes in various ways, too.

patient with diabetes

Parkinson’s disease affects the retina. It's disrupting color vision and altering contrast sensitivity. The early indicators of this chronic condition are exactly these retinal changes, which an eye doctor can see during check-ups.

Alzheimer’s disease manifests as visual disturbances and difficulty with spatial perception. Patients with Alzheimer’s have difficulty processing visual information despite having healthy eyes. This can affect daily activities and mobility, increasing the risk of accidents and falls.

When eye care professionals observe such changes, they can refer patients for neurological evaluation. In many cases, diagnosis of neurodegenerative disorders in their early stages can slow disease progression.

In summary...

Systemic diseases and disorders require constant eye evaluations, not only for diagnosis but also for effective management and prevention of complications. By identifying ocular manifestations of chronic diseases, ophthalmologists also contribute to timely interventions that significantly improve patient outcomes.


Checked by Atanas Bogoev, MD.

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