All about yellowing of eye, cirrhosis eye symptoms, and other eye problems or ocular manifestation of hepatic or liver diseases.
Introduction to Liver Diseases
The liver is an accessory digestive gland that rests on the right side of the belly and is protected by the rib cage. The large, meaty, robbery organ is about 3 pounds in weight.
The liver secretes an alkaline compound, or bile, that helps to break down the fat. So, the liver is a vital digestive gland for the breakdown of one of the essential nutrients of the body.
Other important functions of the liver include the regulation of glycogen storage, decomposition of red blood cells (RBC), and the production of hormones.
Liver disease or hepatic disease is a general term that refers to the compromised functioning of the liver, such as jaundice, Wilson’s disease, hemochromatosis, cirrhosis, among others.
Liver Diseases and Associated Eye Problems
When the normal functioning of the liver is compromised, it affects not only the liver but also the other several vital organs of the body, including the eyes. Let’s have a look at some of the common hepatic or liver diseases and the associated ocular signs and symptoms.
When there is a deposition of iron in the liver or other organs, it is medically known as hemochromatosis. There are two types of hemochromatosis: primary and secondary.
Primary or genetic hemochromatosis is caused by the autosomal recessive gene on chromosome 6 that is closely linked to the A locus of the human leukocyte antigen (HLA) system or complex.
Secondary hemochromatosis is caused by the diseases such as thalassemia or a genetic blood disorder that causes anemia.
In the primary form of the disease, iron deposition occurs only in parenchymal cells whereas, iron is taken by the reticuloendothelial system including bone marrow, spleen, Kupffer cells of the liver in the secondary form.
The body of a normal human has around 3 to 4 gm of iron. When the iron contents exceed the level of 20 gm, it is known as hemochromatosis. Thus, the condition is rarely diagnosed before 40 years of age.
Hemochromatosis Eye Symptoms
Hemochromatosis doesn’t produce severe ocular effects. Although there is iron deposition in a few areas within the eyes, no iron toxicity or visual symptoms is seen.
Iron deposition is predominantly found in the non-pigmented epithelium of the sclera and the ciliary body. Similarly, the free form of iron (ferric) is seen in the conjunctival epithelium and the perilimbal corneal epithelium.
The cutaneous side of the eyelid margin demonstrates the increased pigmentation in the person with hemochromatosis of the liver.
Other common sites where iron deposits occur in hemochromatosis are the cornea and the retina (Angoid streaks).
Wilson’s disease is the deposition of copper in a variety of tissue. It is the hereditary disorder of copper metabolism that spreads throughout the body.
Wilson’s disease is characterized primarily by cirrhosis of the liver, progressive degeneration of the central nervous system, and the Kayser-Fleischer ring of the cornea.
Often the course is chronic with progressive hepatic insufficiency, portal hypertension, splenomegaly. There may be a hepatic failure with rapidly progressive jaundice, encephalopathy, and in some cases early death.
Eye Symptoms in Wilson’s Disease
Kayser-Fleischer ring is the hallmark of Wilson’s disease in the eye. It is formed by the deposition of copper in the Descemet membrane of the cornea.
Sunflower cataract occurs in only one-fifth of the people with Wilson’s disease. It is seen as a fine deposit beneath the anterior and posterior lens capsule, forming a disc-like opacity axially, with tapering spoke or petal-like extensions radiating peripherally
The opacities appear red, blue, green, yellow, and brown, and they don’t interfere with vision.
The human sclera is an opaque, white part of the eye. When the sclera is yellow, jaundice is the most common culprit.
Jaundice is the yellowish staining of the skin, conjunctiva, sclera, episclera, another mucous membrane, and excretions.
Three types of jaundice are hemolytic jaundice, obstructive jaundice, and hepatocellular jaundice.
Jaundice Eye Symptoms (Yellowing of Eye)
Yellowing of the eye, jaundice eye, or scleral icterus is a sign of liver disease or jaundice.
Jaundice may result from an overproduction of bile or from an inability of the liver to remove bile pigments from the blood due to hepatic disease
It accumulates particularly in vascularized conjunctiva and sub-conjunctival connective tissue (Tenon’s) overlying the white sclera. As a result, scleral icterus or yellowing of the eye (jaundice eye) occurs.
Cirrhosis is a slowly progressing, chronic hepatic condition in which the healthy liver tissue is replaced with scar tissue. As a consequence, the liver can’t function properly.
The processing of nutrients, hormones, drugs, and naturally produced toxins is severely affected and slowed as the scar tissue blocks the flow of blood through the liver.
When blood backs up into the portal vein, it can get into the spleen and cause trouble in that organ, too. To date, there is no cure for liver cirrhosis except a liver transplant.
Cirrhosis Eye Symptoms
In addition to the liver, cirrhosis also affects the other vital organs. One of those organs is the eyes. In the eyes, cirrhosis is manifested in the form of following cirrhosis eye symptoms.
- Dry eyes
- Itchy eyelids, eye corners, and the skins around the eyes
- Yellowish conjunctiva and sclera
- Hemorrhages and exudates in the retina
- Occasional night blindness
Hepatitis is inflammation of the hepatic tissue. A person with hepatitis develops a wide range of mild to moderate symptoms, such as yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea.
Hepatitis is classified as chronic or acute Hepatitis, depending on whether it lasts for less than (acute) or more than (chronic) six months.
Acute hepatitis can sometimes resolve on its own, progress to chronic hepatitis, or rarely result in acute liver failure, whereas the chronic form may progress to scarring of the liver, liver failure, or liver cancer.
On the basis of causative agents, hepatitis may be infectious, metabolic, ischemic, autoimmune, genetic. Infectious agents include bacteria, viruses, and parasites. The most common cause worldwide is the virus.
The metabolic causes of hepatitis are drugs, alcohol, toxins, and non-alcoholic fatty liver disease. Likewise, the genetic and the autoimmune causes are genetic predispositions and tend to affect characteristic populations.
The five types of viral hepatitis are type A, B, C, D, and E. Among these, hepatitis D only infects people already infected with hepatitis B.
Hepatitis B Eye Symptoms
- Ischemic retinopathy that gives rise to retinal vasculitis which include artery occlusion, vein occlusion, and cotton wool spots
- Pupil sparing third nerve palsy
- Optic neuritis
Hepatitis C Eye Symptoms
- Chronic hepatitis C virus infection is associated with Mooren-type peripheral ulcerative keratitis
- Ischemic retinopathy
- Dry eye similar to Sjogren’s syndrome
Alagille syndrome is a feature of enterohepatic dysplasia. It is a highly variable autosomal dominant disorder of the body that affect the liver, heart, eyes, a skeleton with recognizable facial dysmorphic feature including triangular faces, prominent quadrangular forehead, and hypertelorism.
Alagille syndrome occurs in 1 baby per 70,000 live births. It is found to be caused by mutations in jagged1(JAG1), a ligand in the notch signaling pathway.
Ocular Manifestation of Alagille Syndrome
The signs and symptoms that are seen in the eyes due to Alagille syndrome are:
- Bilateral posterior embryotoxon
- Ectopia pupil
- Band keratopathy
- Infantile myopia
- Anomalous optic disc
- A pigmentary retinopathy
- Choroidal folds
As we have mentioned earlier, hepatic diseases not only affect the liver but also provides harm to other organs of the body. With the help of the examinations of the other organs, it becomes easier to suspect any associated liver diseases.
Regular health checkup, including liver function test, is crucial to find out any diseases in the early stages. Some of the fatal conditions of the liver can be prevented by early diagnosis and treatment.
Hepatic diseases that affect the eye may cause significant retinal changes and visual disturbances. In some cases, ocular changes are manifested before the systemic changes and may help in the diagnosis of systemic disease.
Eye care practitioners (Optometrists and Ophthalmologists) play an important role to manage the cases of liver disease with the help of ocular findings and timely referral to the department of hepatology.
- Relationship between retinopathy and cirrhosis by Colakoglu Onder, Taskiran Bengur, Dayi Selcuk, Sozmen Bulent, Unsal Belkis, Maden Ahmet, Pasa Eser, and Aslan S. Leyla v.11(14); 2005 Apr 14
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