Charles Bittel, O.D., Inc.

Charles Bittel, O.D., Inc., Newsletter 

Eyes and Your Health 

March, 2011


Charles Bittel, O.D., Inc.

Thank you to all for the wonderful response to the first newsletter. We received a great suggestion from a long time patient and friend for this month's newsletter focusing on eyes and your health.
Many of you are aware that when we look at the back of your eyes not only are we looking for ocular diseases, but we are looking for any signs of systemic health concerns as well. High blood pressure, diabetes, and even high cholesterol can be detected by careful observation of the blood vessels at the back of your eye. Fortunately your primary care physician will likely detect these conditions before changes start to appear in the eyes, but it never hurts to have an extra person looking out for your well-being.
In this newsletter we will discuss a few interesting systemic conditions that you may not have thought could affect the eyes. We hope you enjoy and learn something new!


Charles Bittel, O.D.

Charles Bittel III, O.D.


In This Issue
Featured Article
Thyroid and More
Autoimmune Diseases

Eye Drops
An autoimmue disease is basically a condition in which the body's defense mechanisms attack cells and tissues that are normally present in the body. In Rheumatoid Arthritis the body attacks the joints. In Psoriasis the immune system sends faulty signals to the skin cells. And in Lupus many different organ systems can be targeted by the immune system. While most people are aware of the fact that Arthritis is a condition that affects the joints, many are unaware of the fact that this autoimmune disease and many others can affect the eyes as well.
Dry Eye Syndrome can have a number of causes, but most patients with an autoimmune disease will experience some degree of dry eye symptoms. Our tears are made up of three different layers that when acting together make up a comfortable and stable tear film. The base of our tears is a mucous layer produced by goblet cells. This layer of our tear film helps adhere our tears to the surface of the eyes. The majority of our tear film is composed of the aqueous layer which is produced by the lacrimal gland. This layer is essentially the water-like component of our tear film. And the surface layer of our tears is an oil layer produced by Meibomian glands in our eyelids. This oil layer is responsible for preventing evaporation of our tears.
Tear Film Diagram
Tear Film Diagram


























Unfortunately, some of the tissues and cells that produce these tears are also targeted by the immune system in some autoimmune diseases. If the goblet cells or Meibomian glands are disrupted a poor quality tear will be produced. This will often lead to an overproduction of the aqueous layer of the tear film and a dry eye patient can actually have eyes that water on a regular basis. In other cases the lacrimal gland can be targeted and patients will not produce enough tear volume. This is when the eyes will truly feel dry.


Now just because a patient has an autoimmune disease it does not mean that they will have Dry Eye Syndrome. And just because a patient has dry eye it certainly does not mean they have an autoimmune disease. But there is an association that should be thoroughly explored during an eye examination. And if dry eye is found an eye care practitioner can guide their patient towards the proper artificial tear, prescription drops, or nutritional supplements based on the patient's particular form of dry eye.


Iritis is another ocular disease that can have an association with certain autoimmune diseases. Basically iritis is an inflammation of the iris, or the part of the eye that gives us blue, green, hazel, or brown eyes. If this tissue becomes inflamed, a patient will become extremely sensitive to light. The iris is the aperture that controls our pupil size, so as the iris expands and contracts in response to different lighting situations, it can be very painful when inflamed. One episode of iritis can be idiopathic, meaning it can just happen because it happens, but if a patient has two or more episodes of iritis a work-up should then be performed to rule out an autoimmune disease as the underlying cause.

Thyroid and More

The thyroid is a gland responsible for producing a number of hormones that are related to metabolism and growth. An underactive thyroid gland is known as hypothyroid and can cause general symptoms such as fatigue, weight gain and water retention, and an increased sensitivity to cold. An overactive thyroid is known as hyperthyroid and can cause general symptoms such as weight loss, anxiety, increased sensitivity to heat, and hair loss.
Thyroid Gland
Thyroid Gland
Hyperthyroid is more commonly related to ocular side effects. One of the more subtle effects can be a loss of eyebrow hairs, especially towards the ends of the eyebrows. Some normal loss or thinning of hair is natural with the aging process, but an unequal distribution of eyebrow hair loss towards the ends of the brows may be suspicious. In Graves' disease, an autoimmune disease of an overactive thyroid, the signs can be more obvious when proptosis is present. Proptosis can best be described as a bulging appearance of the eyes that occurs when the extraocular muscles (muscles responsible for our eye movements) enlarge. This is sometimes difficult to distinguish from lid retraction, also present in Graves' disease, when the muscles in the eyelids contract giving the eyes a wide-open appearance. The most common ocular side effect of hyperthyroid is once again dry eye symptoms.  
Both hypothyroid and hyperthyroid have a long list of general symptoms so aside from the proptosis associated with Graves' disease, a primary care physician is the best person to arrive at a proper diagnosis.
There is a long list of of other general health problems that can manifest with ocular complications. As mentioned in the opening paragraph diabetes, hypertension, and high cholesterol all have signs that can be present when looking at the eyes. Patients with allergies might have itchy eyes. Certain skin cancers like basal cell carcinoma can occur around the eyes. Melanoma can even be detected at the back of the eye. And even a recurrent stye in the same location can actually be a rare cancer known as sebacious gland carcinoma. Liver problems such as hepatitis and cirrhosis can cause the whites of the eyes to turn yellow. And even something as basic as Computer Vision Syndrome can present as neck and back aches.
It's always better to be safe than sorry, so if anything seems to be wrong, different, off, uncomfortable, however you want to put it, don't hesitate to give your primary care doctor or eye care practitioner a call. That's what they're there for!
About Us

Dr. Chuck Bittel (Senior) has been practicing in Yorba Linda for over 25 years. His son, Dr. Charlie Bittel (Junior) has been practicing in Yorba Linda and Fullerton for the last 5 years and has just joined his father's practice full-time.


Learn more about Dr. Bittel Senior and Junior and about their practice on their website and Facebook page. Also visit the blog for Computer Vision Services to learn more about Computer Vision Syndrome.


For appointments call 714-779-8521


Charles Bittel, O.D., Inc.
20399 Yorba Linda Blvd.
Yorba Linda, California 92886