Coordinated Care Clarifies The Big Picture

Eyes may be windows of the soul. But they can also be a revealing mirror of the body’s overall health. In addition to the unique advantage of being one location in the body where veins, arteries and nerve tissue can be directly visualized, the eye contains several types of tissue that are susceptible to the problems found it other systems.

The opposite side of the coin is also true. Therapies that heal the body can also affect vision—and not always for the better. Patients benefit from better overall outcomes when those who care for their eyes and their bodies work together.

Physicians are accustomed to looking for yellow eyes as a symptom of hepatitis or liver disease, pupil abnormalities in stroke, tumor and brain injuries, and bulging eyes as a sign of hyperthyroidism. In a thorough eye exam, a number of more subtle clues can be detected that may signal the need for followup.

            “Several systemic diseases have early warning signs that may first show themselves during a routine eye exam,” Mark Swanson, OZD, MSPH, Director of UAB’s Ocular Disease and Low Vision Service said. “For example, in about a third of patients who are developing type 2 diabetes, signs of the condition will be visible in the back of their eyes at the time they are diagnosed.”

            Price Kloess, MD, of Alabama Vision Center also sees early signs of diabetes in his ophthalmology practice. “Cataracts that quickly become worse are a clue that patients should be evaluated for diabetes and other disorders,” he said.

            Other problems ranging from heart disease to cancer are sometimes first seen in the eyes. “Occlusions in blood vessels within the eye suggest the possibility of cardiovascular disease,” Swanson said. “Other changes are associated with some cancers, particularly leukemia.  We can also detect anemia and some neurological conditions.”

            Kloess said, “Eyes that are chronically dry are another strong clue. It may only be allergies that need attention. However, dry eyes are also a frequent symptom of autoimmune diseases and a sign that patients need to follow up with their physicians to check for arthritis, lupus, Sjogren’s syndrome and similar conditions.”

            Changes in eye movement may suggest the need to rule out MS or Muscular Dystrophy. A pale optic nerve may also be seen in MS as well as brain tumors or aneurysms. Droopy eyelids could be a brain tumor or myasthenia gravis. The eyes can reflect infections from HIV to Malaria, endocrine disorders, inherited genetic disorders, and a host of other conditions. Regular eye exams and good communication between health professionals can sometimes make a significant difference in early detection and treatment to give patients the best chance for recovery.

            Looking at the other side of the health equation, it can be helpful for physicians to coordinate care with patients’ eye professionals when prescribing medications that can affect eyes.

            “Patients taking Plaquenil need to be monitored with an eye exam every six to nine months,” Kloess said. “It’s rare, but in some cases the drug has been associated with central vision loss.”

            Swanson said, “In addition to Plaquenil, drugs with a similar structure that react to light, including some of the older antipsychotics, can have a similar effect.”

            Dry eyes may be associated with antihistamines and antidepressants.  Steroids are another type of drug that should be watched for eye symptoms, Kloess said.  Both he and Swanson pointed out an unusual and long-term effect of Flomax, a drug prescribed for prostate and urological problems.

            “It can cause floppy iris syndrome even years after patients stop taking the drug,” Kloess said. “This can make it very hard to keep the eye dilated wide enough to do cataract surgery. In fact, if there is a chance patients need cataract surgery, they might want to have that taken care of before beginning the drug.”

            Swanson said, “Any time patients are prescribe Flomax, they should be cautioned to always tell their surgeon they have taken the drug before they have eye surgery. There are techniques to work around floppy iris syndrome, but the surgeon needs to know to be ready for it.”

            Good advice in general is for patients to bring a list of their medications with them to their eye exam. The list should include dosages, prescription and over the counter drugs, as well as dietary supplements.