What Your EYES Say About your HEALTH Doctor Explains

They say your eyes are the window into your soul. Well, I don't know about that, but I do know that it gives you important information about your health. So, grab a mirror, take a look, and let's get into it. I'm Siobhan, an internal medicine and rheumatology specialist. Let's dive right in with a test for colorblindness. So, take a look at this image. What number do you see? And I'm curious, so let me know in the comments below. If you see the number 74, then that's normal. But, if you see the number 12, then you have some degree of red-green colorblindness, which is the most common type. And it's an X-length genetic condition, which means it's far more common in men. But like most things in life, there's a spectrum of severity, with very few people with complete red-green colorblindness. And optometrists can do extra testing like this to determine the severity and the type. But in this image, if you don't see any numbers at all, then you might have complete colorblindness, which means that you see light, but you don't see colors. So, if you tested positive and you've always had the same vision, then it's probably genetic, don't worry about it. But if this is something new for you, and your vision is changing, then you need to see your doctor, because it could be a sign of something more severe that's happening at the back of your eye, in the retina or the optic nerve. Things like diabetes, sickle cell disease, or even chronic alcohol use. Okay, now let's take a look at the color of your sclera. That's the part of your eye that should be white. If the entire sclera is yellow, it's called scleral ichthyrus. And you cannot ignore this. It means that your body has high levels of bilirubin building up, and it can be a sign of a very serious medical condition. So basically, your red blood cells live for about four months, and after that, they start to break down. One of the byproducts is bilirubin, which then gets processed by the liver. So, when I walk into a room, and I see someone with yellow eyes with scleral ichthyrus, I know that their bilirubin levels are high, and I have to figure out why. Maybe the red blood cells are breaking down too quickly, or the liver itself is damaged, or there could be a blockage in one of the bile ducts. Sometimes, when all the usual testing comes back normal, we discover the person has Gilbert's syndrome, which is really a harmless genetic condition where when someone is stressed or they're really dehydrated, their bilirubin levels can increase. And statistically, about 5% of the population has this, so if you're watching, and that's you, let me know. Okay, now, it's not the first thing you think about when someone says they have blue eyes, but it's possible to have blue sclera. Now, if I see this, my first thought is that this person has some kind of genetic condition that's affecting their collagen. That's because your sclera is made of collagen, and if that becomes thin or transparent, you start to be able to see through it to the middle layer of the eye called the uvea, which has this reddish-blue color to it. So, the classic genetic condition is called osteogenesis imperfecta, and that's when someone has really brittle bones that can easily break. But there's some other conditions you might have heard of, like Ehlers-Danlos syndrome or Marfan syndrome. Okay, onto one you've all probably seen. That's pink eye or red eye. Now, this is a huge topic, and there are so many different causes. A viral infection, bacterial infection, acute ankle-closure glaucoma, scleritis, iritis, a burst blood vessel, or maybe you just got off an overnight red-eye flight. It's just to name a few. But honestly, it can be impossible to tell what it is without a detailed exam and further testing. Personally, as a rheumatologist, I'm always thinking about autoimmune diseases when I see a pink eye. Things like inflammatory bowel disease or psoriatic arthritis, ankylosing spondylitis. There are so many. And I always have to ask people about it because you usually don't think that a red eye can be associated with your arthritis. Honestly, this is a topic I could talk about for hours. But the bottom line is that a pink eye is pretty common, but it can be serious. So if it's not going away, if it's causing you pain, if your vision is changing, and if you're feeling just unwell, you definitely need to see your doctor. Okay, now let's switch it up and test your 3D vision. You might be thinking, doesn't everyone see in 3D? Well, not always. So try this. Take your fingers, put one in front of the other. So it's gonna look like this. First, focus on the front finger. When I'm doing that, notice what the back finger looks like. This finger should actually look doubled. Now do the opposite. Look at the back finger. The front finger should be doubled, like double vision. This is called physiologic diplopia. It's perfectly normal, and it actually tells us that your eyes are working together to make this happen. But if you're not seeing double vision, it could be that one of your eyes is a lot worse or weaker than the other eye, and your brain is sort of ignoring it. We say that your brain is suppressing that eye. And it's actually pretty common in amblyopia, where someone has a lazy eye. And you can actually get vision therapy to help your eyes work better together. Sort of like couples therapy for your eyes. Okay, so since we're talking about your vision, let's do a quick test to check your visual acuity to see if you need glasses or maybe you need a new prescription. So it's called the pinhole test. So make a tiny hole. You can make it with your finger like this. And then look through it with one eye and try to read something at a distance. Does the image look more crisp, more clear? Well, then you probably need a new prescription. You know, my husband Mark actually does this regularly when he's in the shower without his glasses on, when he's trying to read labels and figure out what's shampoo and what's conditioner. Okay, but what does your prescription actually say about your health? So if you're nearsighted, meaning you need glasses to see far away, then your eyeball is actually too long. So this puts you at a higher risk of a retinal tear, which we'll talk about more later in the video, and also more likely to have difficulty with night vision. On the other hand, if you're farsighted, it means that you need glasses to read up close and that your eyes are too short, putting you at increased risk of glaucoma. Basically, the fluid in your eye is constantly draining. And if the outlet gets blocked, then an incredible pressure builds up in the eye, which can damage your precious optic nerve. Okay, now let's focus on the iris, the colored part of your eye. Did you know that nobody in the world has the same eye color as you? It's completely unique, just like your fingerprint. And it can tell you something about your health. So if you have brown eyes, like me, then you have a lower risk of developing eye cancer and a lower risk of damaging the retina from diabetes or macular degeneration. But on the flip side, we have a higher risk of cataracts. But if you have light eyes, it's the opposite. You have a lower risk of cataracts, but higher risk of eye cancer. But either way, the solution is simple. Protect your eyes against the sun. Get a pair of sunglasses that you love because that'll help prevent your risk of cataracts as well as cancer. So if you have two different eye colors, if you were born like that, it's just the way you are. Lucky you, because I think that looks so cool. But if one day you look in the mirror and you notice that one of your eyes is changing colors, that could be a sign of a medical condition. So you need to see your doctor or your optometrist to get to the bottom of it. Interestingly, eye color changes have been reported in people using special serums to grow their eyelashes because it contains a medication called prostaglandins. It seems to affect people with green or hazel eyes the most, causing their eye color to become darker. Okay, now last but not least, probably the most rare eye color is related to a genetic condition where you don't make any melanin called albinism. But the iris isn't actually red. What you're seeing are the blood vessels inside the eye that are showing through the iris. So take a second to show some love for your eyes and leave a heart below with your eye color. Okay, so time for another test. You've probably all heard of someone being right-handed or left-handed, but did you know that you can have a dominant eye? Okay, so try this to figure out which eye is dominant for you. Look at something far off into the distance, make a circle with your hands, and put the object in the circle. So it's gonna look like this, okay? Now close one eye, close the other eye, without moving your head or your hands, and whichever eye has the target more in the center is your dominant eye. So for me, that's my left eye, and that's actually much more rare. It doesn't really have any medical significance, but it does help if you're looking through a microscope or through a camera, use your dominant eye, or deciding which way to stand if you're playing baseball. Okay, now look at the outer ridge of your iris. Do you see a ring around it? Well, a ring that looks golden brown, even a bit green, like this, is called a kaiserfleischer ring. It's caused by a buildup of copper in the body, and the classic genetic condition is Wilson disease. The buildup in the eye is really a great clue to diagnose the disease, but to be honest, I'm much more worried about the buildup of copper in the brain and the liver, that's usually happening at the same time. And we treat the condition with chelating agents to remove the copper from the body. And with treatment, the kaiserfleischer rings often disappear over time. You also might notice a white or gray ring that forms around the iris. Now, this is called a corneal arcus, and it's caused by cholesterol depositing into the eye. Now, the ring itself doesn't cause any damage to the eye, and it's sort of considered a normal part of aging, with almost everyone over the age of 80 having some degree of corneal arcus. So if I see this in a young person, I'm immediately thinking about genetic conditions, like familial hypercholesterolemia. And often, if I go looking, I'll find cholesterol deposits in other places, like on their eyelids or inside tendons. The good news is we have great treatments for this. So if you're under the age of 50 and you notice a ring like this, go to your doctor and get your cholesterol checked. Oh, and one other thing. If you see the corneal arcus only in one eye, even if you're older, you should still go and see your doctor because it's associated with narrowing of the carotid artery, which can put you at higher risk for stroke. So now, you're probably looking closely at your eye, and maybe you've noticed a dark ring around your iris, and you're thinking, is that normal? So if it looks like this, it's called a limbal ring, and studies have shown that in general, people with darker limbal rings are considered more attractive and healthier. It may be because people tend to have darker limbal rings when they're younger, and then they tend to get lighter when they're older, but that's just a theory. But don't worry about it. It doesn't actually represent how healthy you are. So it probably doesn't surprise you to know that contact lens companies have tried to capitalize on this, and I think they've actually created some products that enhance your limbal rings. All right, seems like it's time for another test, don't you think? Okay, so look at this red box on the screen and cover one eye. Really take in that red color, and notice how red it is. Let's call this 100% red. Now, switch eyes and look at the same box. Does it look just as red? Does it look the same? If it looks less red or washed out like this, then there could be a problem with your color perception, which may have something to do with your optic nerve or your retina. So if you're at all concerned, definitely speak to your doctor so you can get formally tested. Okay, next onto a popular topic, eye twitching. We've all had it happen to us. And funny enough, we don't really know why it happens, but we know that it's linked to stress, lack of sleep, caffeine, and that's probably why it happened to me a heck of a lot more in medical school and residency than any other time in my life. It usually happens to your lower eyelid, and it lasts for seconds, maybe hours, but for some really unlucky people, it can last for weeks. And when it's so persistent or it keeps coming back, sometimes we'll actually treat it with Botox to literally paralyze and stop that muscle from moving. For the most part, it's totally normal. Nothing to worry about. Maybe just get a little more rest. But if you notice that other parts of your face are twitching at the same time, or if with every twitch, your eye is actually closing, or it's both eyes that are affected, then those are reasons you should go and see your doctor because something else might be going on. Okay, now onto the pupils. Do you ever wonder why doctors are always shining lights in people's eyes? Well, one thing I'm looking for is called the pupillary light reflex. And you can actually try this at home. So ideally, head into a dimly lit room and look in a mirror, or do it to someone else. Take a light, shine it in one eye, and notice how the pupil changes. It should constrict and get smaller. Interestingly, if you look at the other eye, the same thing should happen at the same time. They should both constrict and get smaller. This is part of the reflex, part of the way the brain is wired. So this is particularly important when I see a patient who's unconscious and I'm trying to figure out what is going on. So if I look at their eye and their pupil is huge and it's not reacting to light, we call that a blown pupil. And it's a really bad sign. It probably means there's been a trauma or maybe a stroke affecting their brain. Checking pupils is also extremely important when you're seeing someone who's sick who may have an overdose or a chemical poisoning. For example, if I see someone who has pinpoint, tiny pupils and they're breathing really slowly, immediately I'm thinking about an opioid overdose. Oh, and another classic one, classic scenario that medical students out there, you guys are going to recognize. It always comes up on exams. Never actually seen it in real life. So a farmer comes into the emergency department confused, delirious, pinpoint pupils and breathing incredibly quickly. You're supposed to think this person has been exposed and poisoned by pesticides. So this is a whole topic in medicine called toxidromes, which I find fascinating. And it's something you see quite often in the emergency department. So if you're looking at your pupils and you start to notice there's this hazy cloudiness over it, it could be a cataract. Basically, the clear lens of your eye gets damaged. Usually this happens with age, but certain things can speed it up, like UV light, smoking, diabetes, and certain medications. Prednisone in particular, which is a medication that I prescribe a lot as a rheumatologist. Sometimes this can happen with kids and teenagers as well. But when this happens, you really need to take a step back and look for a genetic or medical condition that's causing it. In one case, a 16-year-old girl came in with blurred vision, and she was diagnosed with bilateral cataracts. Later on, she ends up saying that she's been really thirsty for months and she's really been peeing a lot, but she didn't think much of it. When she had blood work done, her blood sugar was 42! This is a medical emergency! So she was rushed to the hospital for treatment, and while she was there, she was diagnosed for the first time with type 1 diabetes. Then down the road, when her sugars were well under control, she had cataract surgery and her vision returned to normal. Okay, now let's talk about spots that you might see in your eye. These yellow patches of tissue are pretty common. They're called panguecula and they're generally caused by sun damage, but also things like exposure to wind and dust. The good news is that it's really cosmetic. It doesn't usually cause people any issues. But you really want to protect your eyes so that it doesn't progress and turn into a pterygium like this because that can grow and actually impact your vision. Okay, so now I feel like I'm turning into a broken record. You need to wear sunglasses! Babies, kids, adults, all of us wear sunglasses. You can also get dark spots in your eye, like this is a freckle, an iris freckle. This is a nevus, which is a mole. And this one is a melanoma, which is an aggressive cancer. And just like a spot on your skin, it can be hard to tell if it's cancer, if it's not, but if it's new, if it's changing, definitely get it checked out. Okay, now for something totally different and fun. So try rolling your eyes upwards while closing your eyelids. Can you make your entire iris disappear or can you still see some of the color? This is called the eye roll sign and it's a quick and easy test to see how susceptible you are to hypnosis. The more you can roll your eyes back, the more susceptible you may be to hypnosis, so I think that means I'm pretty susceptible. I really haven't seen hypnosis used very much by doctors, but it has been used for hundreds of years in medicine and in magic shows. Okay, now let's switch gears and talk about your vision, what you're seeing and what warning signs you should watch out for. First, these little guys called floaters. Have you ever seen them before? Don't worry, they're not worms, they're not parasites, they're actually clumps of cells that are floating inside your eye. Most of the time you probably won't notice them, but try looking at the blue sky or a blank wall and you might notice a few. Having a few of these is totally normal, but if you notice a whole bunch of floaters happen all at once, or you're getting flashing lights in your vision, or it looks like a curtain is falling across your vision, well, this could be signs of a retinal detachment, which is a medical emergency. So, why does this happen? Well, when we age, the vitreous, the gel-liquid part inside of our eye starts to shrink and pull away from the retina. Now, in some cases that can cause the retina to tear or even detach from the back of the eye. I cannot stress how important the retina is. Like, the entire structure of the eye is designed to focus light on the retina so that it can send signals to the brain. That's how we see. And the cells in the retina don't grow back. So, they're truly precious. And without them, we're blind. The good news is, there are treatments. So, depending on the size of the tear, ophthalmologists can use lasers to actually seal up the tear. But if it's a full-blown retinal detachment, the ophthalmologist may need to try putting a gas bubble into the eye to push the retina back in place, or put a band around it called a buckle. Okay, let's do another vision test. So, look at this grid, cover one eye, and just look right at the dot in the middle. Now, do the same thing with your other eye. Just look at the dot and see what the grid looks like. If the grid lines look wavy or fuzzy or spots are missing, this could be a sign of macular degeneration, so you need to get checked out. It's another condition that can affect the health of the retina over time. This test is better done if you actually print out a piece of paper and look at the grid, so I'll leave a link in the description so you can print off the PDF and try it. One other emergency that I have to mention is called giant cell arteritis, and this can also cause blindness. This is when your body attacks the blood vessels leading to your eye, and as a rheumatologist, I see this quite often. With a little luck and a lot of prednisone, we can save the eye. So, the bottom line is, if you have a headache and vision changes, you need to see your doctor. Okay, another test. Grab a pen and try this one. Hold the pen at a distance, focus on the tip, and slowly bring it to your nose. How close can you bring it to your nose before the image splits in two? That's what happens for me. This is called your near point of convergence, and a normal result is less than 10 centimetres away from your nose. If it's more than that, then I would guess you probably have difficulty doing tasks up close, like reading. We're actually seeing more of this in kids who have too much screen time. Luckily, there are programs designed to improve this, and we'll get you doing things like pencil push-ups, which will help improve that range. Okay, now let's focus on your eyelids, especially where the eyelashes come out. Has that area ever become burning, itchy, or flaky, especially early in the morning? Or have you ever noticed any changes to your eyelashes, like they're going off in different directions, or falling out? Well, this could be blepharitis, which is basically inflammation of that part of the eyelid. And there are lots of different causes. Things like acne and dandruff can actually be related to this, too. But no matter what the cause, the first step to treatment is eyelid hygiene. And then depending on the exact cause, your doctor can suggest other treatments, like antibiotics, steroid creams, or even tea tree oil to fight off microscopic mites. Yep, you heard me. People with blepharitis often have microscopic mites living inside their eyelash follicles. But before you completely freak out, they're actually normal little critters that live on all of us. I don't know if that actually helps. Personally, I'm really not a big fan of bugs as a whole, especially on me. So when I learned this, I really didn't want to think too much about it. So at least they're so small that you can't feel them, you can't see them, so you can just ignore that I said anything. But just remember that they're not a fan of tea tree oil. Now look at this image. Anyone in healthcare will probably have a diagnosis pop into their mind. So if you're thinking about Graves' disease, you're right. Although, if this made you think of IgG4-related disease, or sarcoidosis, then you're probably a rheumatologist, or you should consider becoming one. So Graves' disease is an autoimmune disease that causes hyperthyroidism. Your body produces too much thyroid hormone. And this causes the muscles behind your eye to become bigger, and fatty tissue can deposit behind the eye as well, which pushes them forward. Fortunately, Graves' disease can be treated, either with medications, or radiation to the thyroid, or even surgery to take it out, depending on your situation. Next, onto droopy eyelids. Now, everyone's eyes are different, and where your upper eyelid sits can vary. Now, if the eyelid droopiness comes and goes, this could be a sign of a rare autoimmune disease called myasthenia gravis, which is a disease that affects the connection between the nerves and the muscle. The classic symptom is muscle fatigability. So repetitive movements, like blinking or chewing, just tire up the muscles really quickly. So one test that we use, and that's really easy, is called the ice pack test. So basically, you take a pack of ice, close your eyes, put it on your eyes for two minutes, take it off, and see if the droopiness improved. So this is a woman with myasthenia gravis, and you can really see the difference in her eyes after just two minutes of putting ice on them. The idea is that the chemical signaling between the nerves and the muscles actually improves at a lower temperature. But this is just one of many different causes of a droopy eyelid. The key is, if it's something new to you, a new symptom, get it checked out by a doctor. Have you ever noticed that at twilight, your vision just isn't quite as good? Well, it's not just you. It happens to all of us. And that's because with such dim light, neither our day vision nor our night vision is really optimized. But when it comes to night vision, what I always hear is people saying, eat more carrots! You need to have more vitamin A! And it's true, a vitamin A deficiency will give you poor night vision. But the truth is, in most developing countries, it's extremely rare to have a true vitamin A deficiency. Unless you've got a medical condition where you're not able to absorb the nutrients. It's far more likely that it's a problem with your retina. Or that you've got a really high minus prescription. Okay, onto dry eyes. Patients talk to me about this all the time. I'd say the biggest things to think about are actually day-to-day stuff, like screen time. Even right now, as you're watching this video, you're probably blinking less frequently. This makes you want to blink more. Also, smoking and contact lenses. Also, your environment plays a huge role, like pollution and low humidity, depending on where you live and the time of year. Common medications that you get over the counter, like anti-histamines and anti-inflammatories. And, of course, autoimmune diseases. My specialty. The biggest one is Sjogren's Syndrome. And this is where the body attacks and damages tear glands so that you're not producing tears. I've had some patients tell me that their eyes are so dry that they physically have to open them up in the morning because they're actually stuck to their eyeballs. It's just horrible. And the list just goes on. So, in general, a good place to start is artificial tears and try to pick out the ones that say lubricating eyedrops. Also, stop smoking, limit screen time, get a humidifier, turn off any fans, and try getting those wraparound glasses that'll protect from the wind. And then talk to your optometrist about any other options. So we talked about dry eyes, now watery or teary eyes. Now, in general, I think of it as either your eyes are getting irritated by something so they're making lots of extra tears and that can actually be pretty serious. Look at all these conditions. It's worth getting checked out to see if you have any of these conditions. So one cause that's actually pretty counterintuitive is dry eyes. Yeah, so if you have dry eyes, then your eyes create lots of tears. So to fix that issue, if you just put in some lubricating eyedrops, it'll soothe the dry eyes so then you don't need to make as many tears. The other option is that your eyes aren't able to drain the extra tears out, and so then they accumulate. So normally, excess tears drain from your eyes into your nose through the nasal lacrimal duct. That's actually why your nose runs when you cry. Because the tears end up going into the nose and mixing with mucus. So, it's sort of like a natural salt water rinse if you think about it. But you can run into problems if that duct is too small, or if it gets blocked or scarred. Depending on the cause, you may need surgery to fix it. They can go in there and cut it open, or they can put a balloon in and dilate the duct to open up. It's actually a very similar process to how we treat a heart attack, and I recently did a video going in-depth into this process, so I'll leave a link so you can check it out. Okay, last but not least, I want to tell you how you can detect an early childhood cancer just by taking a picture. So the condition is called retinoblastoma. It's the most common type of eye cancer in kids, but in the grand scheme of things, it's still very rare. The cancer forms at the back of the eye, so just by looking at someone, you can't see it. But there are many stories of parents noticing that with flash photography, one of their kid's pupils is red, and the other pupil is white. And because of that, they brought them to the doctor early enough that they were able to get treatment. There's actually an app to help with this, and you can detect a normal pupil versus an abnormal pupil in a photo. But just remember, you can't just tell by looking at someone, it's all about how the light bounces off the back of the eye when you take a flash photo. So I want to take a moment to thank Dr. Maria Coward. She's a Canadian optometrist and she's a friend of mine. We worked on this video together, and we just had so much fun brainstorming and coming up with tests to do with you guys. She creates some great educational short content on social media, so if you want to learn more about your eyes, check it out. So this video is part of a whole series looking at different body parts and what it tells you about your health. So check out what your body's trying to tell you by looking at your nails, your hands, or even your tongue. Be sure to subscribe, and that way, I'll see you in the next video. So, bye for now!