Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Maros Misove
Ophthalmologists are medical doctors who specialize in medical and surgical eye care. They are equipped with tools to enable early diagnosis of eye diseases and to allow early intervention where needed. While many people turn up for annual medical check-ups, they often forget that their eyes too require regular checks by a medical doctor. Beyond just vision, a simple eye examination by an ophthalmologist may reveal more about the health of your body than you thought possible.
1. Diabetes, high blood pressure and high cholesterol
Diabetes can affect the blood vessels in the eye and cause bleeding, leaking of proteins and swelling. It is not uncommon that patients are unaware that they have diabetes and have never gone for a check of their blood sugars. These eye changes are easily picked up during an eye examination and prompts further review and assessment of the diabetic status.
High blood pressure can cause bleeding in the retina, leaking of proteins and even swelling of the eye nerve in severe cases. In some cases, it may require a referral to the emergency department for prompt control of the blood pressure to prevent further complications like stroke.
High cholesterol may show up during an eye examination in the form of deposits on the eyelids (Xanthelesma), deposits on the cornea (forming a yellowish ring) and even deposits in the blood vessels. This should raise alarm bells especially if they occur in younger patients and prompts a more thorough investigation.
2. Brain tumours and aneurysms
Brain tumours and aneurysms are potentially life threatening diseases that may present first to the eye doctor. They can cause symptoms including headaches, blurring of vision, double vision and droopy eyelids. At times, a seemingly innocuous comment of “bumping into things” may be enough for eye doctors to do further tests and check the visual fields. Any suspicion for brain tumours and aneurysms usually require further imaging such as a MRI (Magnetic Resonance Imaging) and immediately medical attention.
3. Giant cell arteritis (GCA)
GCA results in inflammation of various organs in the body and can cause life-threatening complications like a heart attack (Myocardial Infarction) and stroke. Patients commonly present to eye doctors first with complaints of headache, scalp tenderness when combing hair, and even jaw ache after chewing food. These triad of symptoms are deeply embedded in the mind of every eye doctor and always requires further investigations including review by the heart doctor and arranging for a biopsy to be done.
4. Connective tissue diseases: Rheumatoid arteritis, Sarcoidosis, Lupus
Connective tissue diseases can cause “red eyes”. While most causes of “red eyes” are self-limiting and leaves no significant visual deficit, the “red eyes” caused by these connective tissue diseases can be more serious, resulting in persistent inflammation in the eye and eventually vision loss. A careful examination at the slit lamp and a fundus examination would reveal this. Co-management with a rheumatologist is often needed for further care.
5. Autoimmune diseases: Myasthenia gravis, Sjogren syndrome
Sjogren syndrome can cause severe dry eyes and myasthenia gravis can result in droopy eyelids and double vision that is not only variable but also worsens with fatigue. The eyes are often the first to be affected in myasthenia gravis. If the disease progresses, it can cause potentially life threatening complications like swallowing difficulties and breathlessness.
6. Thyroid problems
Hyper or hypothyroidism may present first with eye symptoms including noticing that the eyes are more prominent and “bludging”. It can cause sight threatening complications including severe dry eye from exposure and glaucoma. In addition, uncontrolled hyperthyroidism can result in irregular heart rhythms, heart failure and even death.
7. Infections: Sexually transmitted diseases (STDs)
STDs like herpes, syphilis, chlamydia and gonorrhea results in various manifestations in the eye including severe conjunctivitis and corneal “melt”. A high index of suspicion and appropriate testing quickly reveals the nature of these infections. On top of treating these infections, contract tracing is often needed to prevent further spread.
Regular eye examinations with a medical doctor should be done as it really does reveal more than meets the eye. If you haven’t had your eyes checked by an eye doctor in a while, don’t hesitate to book an appointment with me today.