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Effects of Liver Disease on the Eyes

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The complex relationship between liver function and the eye leads to several ocular manifestations of liver diseases. Read to learn more.

Medically reviewed by

Dr. Aditi Dubey

Published At April 23, 2024
Reviewed AtMay 21, 2024

Introduction:

The complex connection between the liver and the eye is observed in several processes, including oxidative stress, metabolism, and inflammation. Numerous congenital, acquired, and familial liver disorders are linked to ocular abnormalities. Early detection of ocular abnormalities may help in the diagnosis of liver conditions. This is especially vital in cases where appropriate therapy can stop liver damage. Determining an accurate diagnosis can provide prognostic information and prevent unnecessary invasive investigations, making it extremely valuable for patients with incurable diseases.

What Is the Mechanism?

Their secretory factors and related cytokines reveal the molecular connection between the liver and the eye. "Hepatokines" refer to certain signaling proteins that the liver mostly releases. These proteins are primarily transported to the liver or other distant organs through the circulatory system, where they regulate various diseases, including inflammatory and metabolic disorders. Certain substances generated by the eyes can remotely impact liver health. A few non-organ-specific cytokines also demonstrate the liver-eye relationship.

What Are the Effects of Liver Disease on the Eyes?

The effects of liver disease on the eyes are,

  • Eyes: Long-term cholestasis is associated with cutaneous eyelid xanthelasma in patients with primary biliary cirrhosis. Approximately 17 percent of instances of primary biliary cirrhosis were found to have xanthelasma.
  • Conjunctiva: Hyperbilirubinemia results in yellowing of the skin and mucosa. Jaundice does not become clinically noticeable until bilirubin levels rise beyond 50 umol/l. The conjunctiva tends to be one of the most sensitive sites for detecting jaundice in people with high skin pigmentation. Leptospirosis (Weil's disease) is characterized by the co-occurrence of jaundice and conjunctival hemorrhage together with fever, gastroenteritis, aseptic meningitis, and acute renal failure. Anicteric leptospirosis can be effectively treated with systemic tetracyclines. Penicillin has uncertain efficacy in treating icteric variants of this spirochaetal infection. Leptospirosis develops in patients who have been exposed to infectious rat urine. Approximately 50% of individuals with primary biliary cirrhosis experience keratoconjunctivitis sicca. Thirty-five percent of patients with chronic active hepatitis also have keratoconjunctivitis sicca. Many adult cases of Gaucher's disease have pingueculae. Penicillin has uncertain efficacy in treating icteric variants of this spirochaetal infection. Leptospirosis develops in patients who have been exposed to infectious rat urine. Approximately 50% of individuals with primary biliary cirrhosis experience keratoconjunctivitis sicca. Thirty-five percent of patients with chronic active hepatitis also have keratoconjunctivitis sicca. Many adult cases of Gaucher's disease have pingueculae.
  • Glaucoma: This may exacerbate the mucopolysaccharidoses. Maroteaux, Lamy, and Scheie's syndromes have been linked to both acute and chronic angle closure glaucoma. There have been reports of open-angle glaucoma in the Maroteaux, Lamy, and Hurler's syndromes.
  • Retinal Diseases: Several liver diseases are caused by systemic illnesses that impact the retina to varying degrees. Consequently, several mucopolysaccharidoses are linked to pigmentary retinopathy, and two sphingolipidoses cause macular "cherry red spot" symptoms. Primary biliary cirrhosis can lead to curable night blindness due to vitamin A malabsorption. Opportunistic retinal and choroidal infections may be linked to immunosuppression after liver transplantation.
  • Pigmentary Retinopathy: It is associated with liver disease. Most cases of Hurler's, Scheie's, Hunter's, and Sanfillipo's syndromes are affected by retinal pigmentary alterations that are morphologically similar to those of other retinitis pigmentosa syndromes. Still, Morquio's and Maroteaux Lamy's syndromes do not exhibit these changes.
  • Vitamin A Deficiency: Malabsorption caused by prolonged cholestasis may result in a deficiency of fat-soluble vitamins. Advanced primary biliary cirrhosis is frequently associated with chronic vitamin A deficiencies and the resulting loss of retinal rod photoreceptor function. This can be avoided with adequate vitamin A replacement therapy. Established night blindness can be recovered if replacement therapy is administered early and at the appropriate dosage.
  • Corneal Diseases: Asymptomatic corneal abnormalities have been reported with Wilson's disease, Alagille's syndrome, primary biliary cirrhosis, and chronic active hepatitis. Hepatomegaly and corneal clouding are characteristics of many mucolipidoses and mucopolysaccharidoses.
  • Wilson’s Disease: The hallmark of this autosomal recessive disorder is an abnormal copper metabolism. Chronic copper buildup damages the liver and the central nervous system. Ascites, splenomegaly, cirrhosis, and bleeding oesophageal varices are the most common presentations of chronic deposition of copper in the liver in children under ten years old. Chronic central nervous system deposition often affects the basal ganglia, which can cause rigidity, spasticity, tremor, and dysarthria. The Kayser Fleischer ring, an essentially pathognomic ocular sign, is a yellow, brown, green, or red deposit of copper in the area of the peripheral cornea near Decemet's membrane.
  • Descemet's Membrane Infiltrations: The appearance of a pigmented peripheral corneal ring without any evidence of neurologic impairment is not always indicative of Wilson's disease. A single case of non-Wilsonian chronic active hepatitis and 3.7 percent of cases of primary biliary cirrhosis were found to have peripheral corneal rings. Additional case reports have reported pigmented corneal rings in cases of severe jaundice and persistent active hepatitis. The regression of Kayser-Fleischer rings successfully eliminates total body copper from penicillamine. Wilson's illness causes copper to accumulate in the lens, leading to cataract development. The Kayser Fleischer ring is almost always present in Wilson's disease patients with neurologic manifestations, and it is also frequently present in other people with Wilson's disease without any neurologic symptoms.

Conclusion:

The mechanisms of liver disease, inflammation, and poor metabolism can significantly impact the structure and function of the eyes. Identifying and treating these ocular symptoms as soon as possible is essential to maintaining visual health and diagnosing and treating underlying liver pathology. It is essential to carry out additional research on the pathogenesis and management of liver-related ocular problems to improve treatments and diagnostic precision, improving the quality of life in affected patients.

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Dr. Aditi Dubey
Dr. Aditi Dubey

Ophthalmology (Eye Care)

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