They could mean a medical emergency

Many serious health problems are first diagnosed from changes in the eyes. Never ignore these eye symptoms…


What it may mean: If you notice that one of your eyelids has abruptly drooped lower than the other (possibly accompanied by double vision), it could indicate an aneurysm — a ballooning-out of a blood vessel in the brain. This is particularly likely when a patient’s pupils are unequal in size. An aneurysm can press against nerves that control both eyelid position and pupil size.

Aneurysms aren’t always dangerous, but those that rupture can cause brain damage or death. It’s estimated that up to 5% of Americans will have a brain aneurysm in their lifetime.

Causes: Most brain aneurysms are due to a natural weakness in an artery wall. Less often, they’re caused by head trauma.

What to do: Get to an emergency room immediately.

Treatment: Aneurysms that are large and/or are causing symptoms are typically clipped — a neurosurgeon uses a metal clip to prevent blood from flowing through the aneurysm. Small aneurysms often are best left alone.


Chronic eyelid droop sometimes is accompanied by blurred or double vision, jaw fatigue or general weakness that gets worse as the day progresses.

What it may mean: These are common symptoms of myasthenia gravis, a condition in which nerves are unable to communicate effectively with muscles.

Causes: Myasthenia gravis is an autoimmune disease. The immune system creates antibodies that damage cellular receptors for acetylcholine, a neurotransmitter involved in nerve/muscle communication.

It’s not clear what triggers this condition, although it has been linked to disorders of the thymus gland.

What to do: Get to a doctor as soon as possible (ideally within a week). If your symptoms are accompanied by respiratory problems, you should get to an emergency room immediately.

Treatment: Most patients are treated with medications, such as pyridostigmine (Mestinon), which improve the transmission of nerve signals. Other medications, including steroids, may be used. The thymus gland may be removed in patients with tumors if medication fails. This may or may not improve symptoms — it is mainly done to reduce the risk for a future cancer.

EYEBALL PAIN (often sudden)

What it may mean: In the absence of trauma, eye pain can be due to glaucoma, a buildup of pressure within the eye. (Other causes of eye discomfort are inflammation in the eye or dry eyes.)

Causes of glaucoma: The different forms of glaucoma all cause an increase in intraocular pressure. This usually is due to impairments in drainage, which increase fluid levels within the eye.

Important: Glaucoma is the second leading cause of blindness among American adults (behind macular degeneration). Eye pain may be the only early symptom.

What to do: If you have severe pain and/or vision loss, get to an ophthalmologist within a day.

Treatment: Medications that reduce pressure by improving drainage and/or reducing fluid production. Examples: Medicated eyedrops, such as timolol (Timoptic) or brimonidine (Alphagan). Surgery also may be needed to improve eye drainage.


What it may mean: A clot in a blood vessel may be blocking circulation to the retina, optic nerve or brain. Patients with this type of clot may be suffering from a stroke or be at high risk for a subsequent stroke — possibly within hours or days. (Other conditions that can cause these symptoms include inflammation in the blood vessels, a retinal detachment or inflammation of the optic nerve.)

Causes of stroke: The same risk factors for cardiovascular disease, such as diabetes, high blood pressure and smoking, also increase the risk for stroke. The optic nerve and retina are very sensitive to changes in blood flow. Even a partial blockage can cause visual changes — and these changes may ­occur long before an actual stroke.

Important: Small clots that cause visual changes often dissolve on their own. Symptoms disappear — but the stroke risk still is there. Also, if you’re having a stroke, you may not be aware of any symptom — an onlooker may be the one to alert you to a shift in behavior.

What to do: Get to an emergency room, even if the symptom is fleeting.

Treatment: Patients with clots (or a history of getting them) usually are treated with clot-dissolving (or clot-preventing) therapies. These include aspirin, heparin, warfarin or tissue plasminogen activator (tPA).

A procedure called carotid endarterectomy may be recommended for patients with large amounts of plaque in the carotid arteries. Fatty buildups in these arteries, which run from the neck to the brain, increase the risk for subsequent strokes. A test called the carotid doppler can be used to detect and measure the plaque.


What it may mean: We all see drifting specks, or “floaters,” from time to time. They occur when the clear jelly inside the eyeball (the vitreous humor) releases strands of cells that are briefly visible. Occasional floaters are harmless — but a dramatic swarm of floaters or flashing lights can indicate a developing retinal tear or detachment, which, without immediate surgery, can cause blindness.

Causes: The retina, a light-sensitive structure at the back of the eye, can separate from the blood vessels behind it. This often happens when the vitreous humor leaks through a small tear in the retina, weakening the supportive bonds. A tear in the retina may be caused by age-related changes, trauma or extreme nearsightedness. The longer the retina remains detached, the less oxygen it receives — and the greater the risk for subsequent blindness.

What to do: See your ophthalmologist promptly — the sooner, the better. Don’t wait longer than 24 hours.

Treatment: Surgery to repair the tear often is effective, but it can take months for vision to improve — and some people don’t ever fully regain their normal vision.

Note: A swarm of floaters also can be caused by bleeding in the eye due to other conditions, such as abnormal blood vessel growths. This usually occurs in patients with diabetes, hypertension or sickle-cell disease.