Something’s Wrong with the Windows: Twenty Eye Problems that Might Indicate Disease

Do you know what you call a deer with no eyes? No idea! Although we “see” with our brain, it is the eye that captures the instrument panel, runway lights, different aircraft, and other stuff like flowers, trees, and the faces of family members! 
Photo by David Tulis
As  our eyes are protected by eyelids that blink every few seconds and distribute lubricating and moistening tears, which are then washed away, light enters the pupil and is focused by the cornea (the thin covering membrane) and an internal lens. Passing to the back of the eye, images hit the retina, where special nerve cells send a message to the brain which interprets the data. Issues with any of these structures might indicate a local or generalized disease and while I hope you find this interesting, the simple message is this: If you notice any change in your eyes, get to a doctor rapidly!

1. Bags: Sagginess in the lower lid, perhaps with dark areas, is due to looser skin and redistributed fat. Although there is a genetic element, this is more common as people age.
2. Lumps: On the eyelid, these might be benign or malignant tumors or cysts. Additionally, cysts may develop near the eyelashes. If painless, they are called a chalazion but can grow and either become infected or press on the eye, adversely affecting vision. A painful lump on the hairline is called a sty or Hordeolum – these are bacterial infections of a hair follicle duct.
3. Squinting: If someone is squinting their eyes and this is a new development, it probably means there has been a change in vision and it is time to get an eye checkup. Doing this once a year makes sense, especially as pilots rely on good vision!
4. Twitching: The hundred-dollar word is blepharospasm and it may simply be a learned “tic” but can also be a sign of nervous system diseases like Parkinson’s, can be initiated by certain drugs, and in rare circumstances can be chronic and very uncomfortable, in which case a surgical procedure to relieve pressure on the relevant nerve is a good solution.
5. Bulging eyes: This is a classical indication of thyroid problems like Grave’s disease.
6. Different directions: Amblyopia, our word for lazy eye. Usually seen in young children, it can develop later in life if, for instance, the lens is clouded.
7. Other asymmetry: If one eyelid is drooping that may indicate a tumor or enlarged blood vessel, an aneurysm, is pressing on a nerve. 
8. Drooping: If both eyelids droop, as well as a wandering eye, that might indicate myasthenia gravis, an autoimmune disease that causes neurological problems such as muscle weakness.
9. Dry eye: This can be caused by aging, being poorly hydrated, various drugs like antihistamines, impaired eye closing, perhaps from a nerve palsy and connective tissue problems like rheumatoid arthritis.
10. Pupil size: The iris is the circular, muscular, colored part of the eye and the hole in the middle of the donut is the pupil. Brighter light causes the pupil to get smaller and although normally the same size, one pupil can be smaller than the other and not be a problem and is called anisocoria. However, if a change is seen this can indicate problems with nerves supplying the eye, common with Horner’s syndrome, or may indicate prior trauma to the eye.
11. Pupil color: Usually pupils are the same color but rarely they are different, a condition called heterochromia – if you google an image of the actress Mila Kunis you will have a sense of the appearance. The late, great David Bowie was said to have different-colored eyes, but in his case it was due to the pupil size issue referenced above, anisocoria.
12. Pinkeye: This is often due to a bacterial infection (in which case it can be easily transmitted to family members), allergies, or an inflammatory condition like systemic lupus erythematosus.
13. Yellow eye: If there is a yellow ring around the iris this might indicate an issue with fats in the blood and should be tested. If the cornea is generally yellow this is indicative of jaundice and liver, bile duct, or pancreatic disease or a rapidly spreading cancer and merits immediate attention.
14. Spots: Eyelid skin bumps have been referenced in #2 above, but one can get moles in the eyeball itself. If in the cornea, they are easy to see and most are harmless. If on the retina, one needs to use an ophthalmoscope to gaze into your baby blues, an important part of every eye exam as will become abundantly clear.
15. Gray rings: With age, a grayish-colored ring called arcus senilis appears around the edge of the iris and has little significance.
16. Brown rings: In Wilson’s disease, a problem with copper storage, rusty brown Kayser-Fleischer rings develop around the iris.
17. Diabetes: When an eye doctor uses an ophthalmoscope, they may see leaky blood vessels or other changes indicative of diabetes. For those who already have the disease, a regular eye exam is critical as it can help stave off blindness.
18. Hypertension: Similarly, changes of raised blood pressure manifest on the back of the eye as a changed “silver wire” appearance of blood vessels or other changes.
19. Bulging at the back of the eye: This has a very specific appearance and indicates an increase of pressure inside the skull. Although there are a number of causes, one always wants to rapidly rule out a brain tumor.
20. Pressure: During an ophthalmic exam the doctor will measure pressure within the eye with a machine that puffs air on the front of the eyeball. This is used to diagnose glaucoma early – which gives the best chance of treatment helping delay blindness.

So, see your way clear to check your eyes every now and then and if the person in the mirror has changed, file a flight plan to visit your eye doctor. Do you know what music might be playing in his office? iTunes!
Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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