How a cardiologist looks at this problem

The heart which pumps blood to all the arteries, veins and tiny vessels called capillaries also reaches the eye
Representational Image
Representational ImageSource: Pixabay

Eyes are often referred to as the windows to the soul. Looking into the eyes of a person can reveal the emotional status of the person even without striking a conversation. But can eyes also act as window to the heart and the cardiovascular system? The answer is yes.

Retina of the eye is the only place where a doctor using fundoscopy can see the pulsating live blood vessels. The look of the blood vessels and the surrounding tissue can easily differentiate between a healthy person and a person with long standing high blood pressure, diabetes or a person with infected heart valves.

The heart which pumps blood to all the arteries, veins and tiny vessels called capillaries also reaches the eye.

The persons with high BP make the eye artery walls thick and show compression as nicks over the veins, haemorrhages, yellow hard exudates and swelling of the disk. These are called target organ damages in high BP patients.

Other target organs affected can be kidneys, heart and brain. Patients with these changes are more prone to strokes and heart attacks. Thus, a person going for a routine eye examination can get these warning findings and an effective BP control certainly can help in preventing or reducing these outcomes.

Likewise, eye examination in a long standing diabetic can reveal signs of eye damage. The fundoscopy can show haemorrhages, small areas of dilatation of the retinal vessels (aneurysms), serious vitreous bleeds and even areas of retinal detachments.

These initially go un-noticed by the patient who continues to remain asymptomatic. However, symptoms like dark spots in front of the eyes, blurred vision, fluctuations in vision and loss of vision can eventually come. Eye examination thus can be a very useful periodic examination in diabetics both Type 1 and Type 2.

Early diagnosis and treatment of these abnormalities can be eye saving and also point towards a complicated diabetes which is a common cause of heart attacks and strokes. In fact, at least one third of diabetics have high BP and this combination also called “deadly duo” can play havoc if not treated effectively.

Some middle aged and elderly persons develop yellowish soft cholesterol filled small pain less bumps around their eye lids, these are often indicators of high bad cholesterol (LDL c) levels.

Development of these tiny bumps should prompt the person to get a lipid profile done. These are also common in people with genetic or familial disorders of hypercholesterolemia.

Normal LDL cholesterol levels should be less than 100 mgs/dl. Thus, an examination of eye lids can help in un ravelling the issues of high bad cholesterol levels. Cholesterol depositions around the cornea can create a light grey or blue ring circling it. It is called “arcus senilis”, a feature of ageing.

Sudden changes in vision such as blurriness or black spots in front of eye can be because of the blockage of a blood vessel of the eye. This can be diagnosed by fundoscopy of the eye.

These subtle changes in the eye are often accompanied by serious cardiovascular disorders and should lead to a full evaluation of the heart to diagnose cardiovascular disease.

Besides this eye examination can give a clue towards a leaking heart aortic valve; A sign described in 1909 where the pupil of the eye alternately enlarges and constricts (a pulsatile pupil).

Infected heart valves (Infective endocarditis) a serious medical condition can affect the eyes and can reveal the disease justifying an eye examination which can show occlusion of retinal artery and black spots called Roth spots, inflammation of the retina and endophthalmitis. Eye involvement is an independent predictor of poor prognosis including death.

Besides the eye as a window for heart related issues, eye also gets tell-tale signs in several other systemic diseases like, hyperthyroidism, rheumatoid arthritis, SLE, AIDS and multiple sclerosis. This all indicates the importance of examining eyes which is becoming a forgotten art by the current generation of clinicians.   

Take Home Message:

Eyes are not only windows for the soul but peeping in them can unravel several mysteries of the heart and the vascular system at a very low cost. These include changes in high blood pressure, diabetes, high cholesterol levels, changes of ageing and heart valvular problems like leaks and infections.

These target organ changes should alert the treating doctor to treat these underlying problems aggressively thus preventing problems like heart attacks, strokes and heart failure before they manifest in their full form endangering the survival.

Examining the blood vessels and the retina of eyes through these windows should not be given up despite the availability of high technology in modern health care.

People often call eyes the windows to the soul. But what exactly do we see when we gaze into the eyes of another person? In fact, the eyes do provide lots of information about another person’s emotional state.  

When people are sad or worried, they furrow their brow, which makes the eyes look smaller. Yet when people are cheerful, we correctly call them “bright-eyed.” That’s because people raise their eyebrows when they’re happy, making the eyes look bigger and brighter.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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