Impacts of hepatitis on eye health

23/07/2024

Hepatitis can have repercussions on vision. Although not extremely common, certain ocular effects can occur due to complications of the disease or associated treatments.

Ocular manifestations of hepatitis

• Scleral jaundice: One of the most visible signs of hepatitis is jaundice, which can cause a yellow discoloration of the sclera (the white part of the eye). This occurs due to the buildup of bilirubin in the body, a pigment that the diseased liver cannot process properly.
• Dry eye: Some hepatitis patients, especially those with chronic infections such as hepatitis C, may experience dry eye. This may be related to autoimmune disorders that sometimes coexist with hepatitis C, such as Sjögren's syndrome.
• Subconjunctival haemorrhages: Blood clotting problems associated with advanced liver disease can cause subconjunctival haemorrhages, where red spots appear on the sclera of the eye due to small broken blood vessels.

Complications of hepatitis treatments

• Interferon and ribavirin: These medications, used in the treatment of hepatitis C, may have ocular side effects. Interferon can cause retinopathy, characterized by retinal haemorrhages and cotton wool spots on the retina. Ribavirin, for its part, can cause dry eyes and, in rare cases, retinal lesions.
• New antiviral therapies: Although the new direct-acting antivirals for hepatitis C have fewer side effects than previous treatments, they can still cause eye problems in some patients, such as blurred vision or changes in vision. Very rarely, a generalized immunoallergy condition is possible, which would also affect the eyes.

Related systemic diseases

• Autoimmune hepatitis: This form of hepatitis may be associated with other autoimmune disorders that affect the eyes, such as uveitis (inflammation of the uvea, the middle layer of the eye) and scleritis (inflammation of the sclera).
• HIV coinfection: Patients with both hepatitis and HIV may be at increased risk of developing eye infections and complications due to a compromised immune system.

Indirect effects

• Severe liver damage: Advanced liver failure can lead to systemic complications that affect blood circulation and clotting, which could have indirect impacts on eye health. For example, portal hypertension, which is an abnormal increase in blood pressure in the portal vein (carrying blood from the intestines to the liver), can cause vascular changes that affect the retina.

Although the ocular repercussions of hepatitis are not extremely common, they do exist and can range from mild effects such as scleral jaundice to more serious complications such as drug-induced retinopathy. It is crucial that hepatitis patients are aware of these possible effects and undergo regular eye checks. Early detection and proper treatment of any eye problem can prevent serious complications and preserve visual health.

Dr. Rubén Delgado, ophthalmologist at the Barraquer Ophthalmology Centre