doc
Spring 2014 • Kentucky
Common Ophthalmologic Symptoms that Can Indicate
a More Serious Problem
By Dr. Jenny Wheeler
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.
5