Many systemic diseases reflect in the eye
DR R. Kumar

When Silky, a case of severe chronic headache, entered an eye specialist’s chamber, she was deeply fearful of an adverse outcome as it happened in the case of her mother, who was diagnosed as a case of brain tumour and her father declared to be suffering from hypertension for the first time by the eye specialist. Both were earlier referred to the eye specialist due to perpetual headache and were not diagnosed elsewhere.

Silky had already got her MRI scanning done, which was normal. “You are an eye doctor. How do you diagnose diseases like brain tumour and high blood pressure?”, enquired the girl in her panic-ridden voice. The doctor said after examining her that she needed only eye glasses as treatment for her headache. However, eyes may get involved in several diseases, and an eye specialist can be your friend and your physician in several other situations besides headache. These are:

n Diabetes mellitus – an imbalance in blood sugar levels.

n Acquired immunodeficiency syndrome (AIDS).

n Graves’ disease – a thyroid disorder, with swelling in the front part of the neck and protruding eyes.

n Sarcoidosis – a disease that mainly affects the lungs, brain, joints and eyes, found most often in young women.

n Systemic lupus erythematosus involving mainly the skin, joints and kidneys.

n Rheumatoid arthritis.

n High blood pressure.

n Atherosclerosis (hardening of the arteries) and heart disease.

n Sickle cell disease –an inherited blood disorder that can block the circulation of retina.

n Multiple sclerosis – a disease that damages nerve coverings, causing weakness, coordination and speech disturbances.

Stroke.

How do systemic diseases affect the eye?

Diabetes can cause severe eye complications, including swelling of the retina (macular edema), abnormal growth of new retinal blood vessels and bleeding inside the eye.

Diabetic retinal disease is a leading cause of blindness in India. In addition, people with diabetes develop cataracts earlier than other people. Therefore, it is important for them to have regular eye examinations done.

AIDS can cause infections in the eye, retinal detachment, eyelid tumours and neuro-ophthalmic disorders. AIDS-related infections can often lead to blindness, but effective eye treatment is now available. Abnormal retinal circulation is another frequent complication of AIDS. Sometimes, the first signs of AIDS are abnormalities in the retina.

Graves’ disease can cause protruding eyes (proptosis), limitations of eye movement, double vision and corneal disease. Severe cases may have damage to the optic nerve. Sometimes the eye symptoms in Graves’ disease can appear before other symptoms and signs.

The eye is prone to inflammation. A type of inflammation called uveitis is the most common eye problem caused by sarcoidosis. Uveitis can result in painful and red eyes, blurred vision and glaucoma. Scleritis, an inflammation of the white part of the eye, can result from systemic lupus erythematosus and rheumatoid arthritis. Both of these conditions also can cause dry eyes.

High blood pressure and atherosclerosis can damage the retinal blood vessels. In persons with high blood pressure, the extent of damage in the eye can directly relate to the damage that occurs in the kidneys. High blood pressure can be first diagnosed when changes in the blood vessels of the eye are found. Sickle cell eye disease can sometimes lead to blindness if not treated with laser therapy. Multiple sclerosis can cause eye movement problems as well as the optic nerve disease leading to the loss of vision.

Cancer can start in the eye or can spread to the eye. Early detection and treatment of cancer in the eye can be vision-saving and, in some cases, life-saving. Brain tumours also may affect vision by causing swelling of the optic nerve. Occasionally, a doctor may first suspect a brain tumour after finding optic nerve swelling on an eye examination. Thus, an eye specialist has an important role to play in managing systemic problems besides the problems of vision.

The writer is Chandigarh-based eye-specialist.

Who is prone to chilblains?
Dr Harsh Sharma

Swelling, itching and pain of the fingers of the hands and feet are a common problem in late December and January in the northern part of our country. Intense cold, rain and fog often occlude the sun and add to the misery of people, particularly those who are susceptible to chilblains.

Chilblains is an abnormal reaction of the body, more specifically, to the extremities, to exposure to cold temperature. Small blood vessels or capillaries are damaged due to extreme cold. It happens mostly in the small toes of the feet but may also occur in the hands and even on the nose or ear lobes. These areas become red, swollen and painful. Burning and itching are the usual accompanying symptoms. Some people may even have blisters on the skin. In the case of some people, it happens year after year while others are not at all affected. The precise reason for this difference in incidence is not properly understood. People who are most affected usually have poor blood circulation to the extremities. This poor circulation may be on account of anaemia, lack of exercise, inadequate diet or simply old age. Somehow, for reasons not clearly understood by medical science, women are more likely to develop chilblains. At the same time, people who are thin or rather underweight by 20 per cent or more are also more prone to this malady.

Do’s and dont’s

Prevention, as is true in the case of other problems, is better than cure in chilblains. Keeping the whole body warm and not just the feet or hands is important. It is better to wear two or three layers of warm clothing instead of just a single heavy one as they can trap the heat of the body better. The role of a balanced diet is often overlooked in the prevention of chilblains. Anaemic people often have a poor circulation and they are likely to develop chilblains more commonly.Taking a balanced and adequate diet goes a long way in the prevention of anaemia and also prevents many other complaints.

Controlling chilblains requires a regular walk as it helps in improving blood circulation as well as building the resistance of the body. At the same time, care ought to be taken to avoid exposure to low temperature and fog in the morning. Wearing tight or ill-fitting shoes may also contribute to this trouble.

It is a common practice to rub one’s hands and feet in the cold weather. This is not a good habit, particularly for those who are prone to chilblains. In case one has had a prolonged exposure to cold, one should not try to warm the feet or the hands by directly exposing them to fire or any other source of heat as hot water bottle or a heater. It is important to understand that sudden changes in temperature inflict injury to the tissues and exacerbate the problem. Instead, it is better to warm the hands and feet gently by covering them by blankets, putting the hands in pockets or wearing woollen socks.

Homoeopathic medicines are very effective in not only treating the malady but also preventing its recurrence. The right selection of the medicine is dependent upon the individual symptoms which can vary from person to person.

The writer is a Mohali-based homoeopathic practitioner. Email --drharshsharma@gmail.com.

Managing ulcerative colitis
Dr. R. Vatsyayan

A chronic inflammatory disorder of the large intestine, ulcerative colitis is a worldwide health problem. Most commonly it begins during adolescence and early adulthood, but there have been cases of this disease having stricken youngsters and the elderly. Closely related to another inflammatory condition of the colon called Crohn’s disease, ulcerative colitis is marked by wide-ranging symptoms such as passing loose or mucous-containing stools with intermittent rectal bleeding, retention of gas, abdominal cramps, acidity, occasional fever and general weakness. A majority of the symptoms and the pathology of the disease resemble the condition called ‘raktatisar’ as mentioned in ayurvedic classics.

Though definite causes of ulcerative colitis are not known, scientists today believe that most likely it involves the abnormal activation of the immune system in the intestines and such continued action causes chronic inflammation and ulceration. Of the aggravating factors, stress and dietary indiscretions come on top, but, etiologically, susceptibility of genetic inheritance of the patients with inflammatory bowel disease is also talked about. According to ayurveda, it is the disorder of vitiated ‘pitta’, when wrong diet and other lifestyle problems can become a predisposing cause for ulcerative colitis.

Apart from diarrhoea and rectal bleeding, the most common symptoms of ulcerative colitis, the disease doesn’t affect all the patients in an equal manner. Generally, patients having inflammation confined to the rectum and a short segment of the adjacent colon have milder symptoms. But an increased involvement of the large intestine like the left colon, the transverse colon and the right colon produces more severe symptoms which include blood-spattered diarrhoea, abdominal pain, malabsorption, weight loss, fatigue and fever. Relapses and remissions of these symptoms is a marked feature of this disease.

Ulcerative colitis is known to follow a unpredictable course, and most of the times active treatment continues for years and the complications of this disease include anaemia, arthritis, low backache and rarely cancer of the colon.

The ayurvedic approach regarding the treatment of ulcerative colitis is to evolve a favourable diet plan supported by a regime of medicines which control bleeding and diarrhoea and reduce swelling in the colon. Patients of ulcerative colitis should eat small, light and easily digestible meals. ‘Chapatis’ of whole cereal ‘atta’ of wheat and maize or ‘chapatis’ made by mixing these two accompanied by non-fried dishes of vegetables and light lentils are good for them. Rice and its combination with lentils or khichdi also make a good meal for such patients. Use of curd and buttermilk instead of other dairy products like milk and cheese find overwhelming recommendation for persons suffering from this disease. Fruits like banana, mango, pomegranate and apple can also be taken.

Moderate use of certain digestive herbs like jeera, ajwain and hing help allay intestinal spasm and gaseous conditions commonly found in the patients of ulcerative colitis. Of the vast array of medicinal herbs, pulp of half-ripe bael fruit occupies an exalted position in treating the disease. Nagarmotha, kutaja bark, mochras, atees and sonth are some of the other herbs which reduce the inflammation of the colon, decrease the frequency of stool and lessen the passing of mucous and blood. Taking daily two tea-spoonful of isapgol husk with a bowl of curd also helps bind loose stools.

Depending upon the chronicity and severity of the case, classic ayurveda recommends many medicines for ulcerative colitis. The famous ‘Parpati’ regime with a preference for Vijay Parpati or Panchamrita Parpati should be given in the flare-up phase of the disease. Piyushvalli Rasa, Gangadhar Rasa, Praval Panchamrita Rasa, Sajivani Vati, Kutajghan Vati and Shankh Vati help reduce the frequency of stools. Bilvadi Churna, Gangadhar Churna and Vatskadi Qwath are also some of the other well-known classic ayurvedic medicines which are being used to treat ulcerative colitis since time immemorial.

The writer is a Ludhiana-based senior ayurvedic physician and Guru at the Rashtriya Ayurveda Vidyapeeth. E mail- ayu@live.in