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Eating Disorders and their Impact on the Eyesi
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Eating can be considered disordered when the intake of food is either uncontrollably
insufficient or excessive for healthy living. This may mean eating very small portions of food,
overeating or purging of food through vomiting or use of laxatives. These disorders often
start during the teenage years, but can occur at any time during life. Typically disordered
eating patterns have been seen as a feminine issue but it is not uncommon for men to have
eating disorders.
Eating disorders are real, treatable medical illnessesii. They frequently coexist with other
illnesses such as depression, substance abuse, or anxiety disorders and maybe lifethreatening if a person does not receive treatment. Anorexia is associated with the highest
mortality rate of any psychiatric disorder. Typically anorexia involves restricting food and
diet while bulimia involves vomiting or purging of food as well as binge eating.
All Eating disorders have an impact on mental and physical health, not just for the individual
but also for friends and family. They can lead to death, serious health conditions and much
more. This essay will focus on the effect that eating disorders can have on the eyes and
vision.
Anorexia nervosa
Many people with anorexia nervosa see themselves as overweight, even when they are clearly
underweight. Eating, food, and weight control become obsessions either by restricting the
intake of food, eliminating food so it is not available for digestion or through extreme
exercise.
A study published in the British Journal of Ophthalmology suggested that anorexia can
cause permanent eye damage. This was a small study of 33 women with an average age of
28. 13 had been diagnosed with anorexia for 10 years: the remainder were considered
healthy.
The study focused on the functioning of the macula area which is the most metabolically
demanding area of the human eye. All the women appeared to have a normal standard of
central vision when tested using standard tests of sight but on a cellular level differences were
found between the two groups of eyes. The macula and its accompanying nerve layers were
significantly thinner and there was less electrical activity in the eyes of those with anorexia.
Bulimia nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating unusually large
amounts of food and claim a lack of control over these episodes. This binge eating is
followed by behaviour that compensates for the overeating such as forced vomiting,
excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these
behaviours.
Unlike anorexia nervosa, people with bulimia nervosa usually maintain a healthy, normal
weight, or maybe slightly overweight. But like people with anorexia nervosa, they often fear
gaining weight, want desperately to lose weight, and are intensely
unhappy with their body size and shape, many suffer from feelings of
disgust or shame due to their secret purging. The binge eating and
purging cycle can happen anywhere from several times a week to many
times a day.
Bulimia can have a negative impact on the human eye. One of the main eye related
problems associated with bulimia comes from the added pressure that vomiting places on the
eye, especially on the blood vessels, often resulting in broken blood vessels in the external
eye. These conjunctival haemorrhages are not painful, but can be easily seen by others as
they make the eye appear red. No long lasting vision problems typically result from
conjunctival haemorrhages however the strain of excessive vomiting can result in a retinal
detachment within the eye which does require urgent surgery.
Vomiting also stresses the digestive tract which results in an imbalance of electrolytes which
are necessary for a healthy cardiovascular system and for good visual function.
Binge-eating disorder
People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa,
periods of binge eating are not followed by compensatory behaviours like purging, excessive
exercise, or fasting.
As a result, people with binge-eating disorder often are overweight or
obese so are at higher risk for developing cardiovascular disease and high
blood pressure. They also experience guilt, shame, and distress about their
binge eating, which can lead to more binge eating.
Obesityiii
It is difficult to establish a direct link between obesity and the eyes however many
conditions secondary to obesity are known to have consequences for vision and the eyes.
Inflammatory conditions are associated with obesity so the implication is that any condition
with an inflammatory element could be aggravated by excess weight. Other conditions which
might be adversely affected by
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Probably the most common manifestation of an ocular inflammatory condition is dry
eye, so one line of treatment would be to address any weight issues
Based on the current data, obesity is likely associated with cataract. However, there is
still controversy regarding which type of cataract is related to obesity.
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There is considerable evidence from clinical studies to support an association between
obesity and higher IOP. However, current evidence of a direct association between
obesity and glaucomatous neuropathy is weak.
There is considerable evidence that supports an association between obesity and agerelated maculopathy. The nature of this association with the different types of ARM
and the role of weight loss in preventing the development or slowing the progression
of ARM, however, remains to be determined
Lifestyle changes, such as weight loss, have been advocated as a key factor in helping
prevent diabetes and to delay diabetic complications including retinopathy in
susceptible patients.
Obesity has been recognised as a significant risk factor for retinal vein occlusion in a
very limited number of studies
Other ophthalmic conditions may also be associated with obesity. For example, it has
been suggested that obesity may be related to oculomotor nerve palsy. Obesity has
also been associated with recurrent lower eyelid entropion. Obstructive sleep apnoea
syndrome, a common co-morbid condition related to obesity, has been associated with
papilloedema and floppy eyelid syndrome. Moreover, obesity is also a risk factor for
benign intracranial hypertension.
Prader-Willi syndrome, an obesity-associated condition, was found to be related with
a number of ocular abnormalities including myopia, astigmatism, amblyopia,
strabismus and exotropia.
For the above conditions and given the current lack of definitive proof weight control is best
aimed at prevention or as an adjunct to treatment to address the underlying cause associated
with the excess weight.
However Insulin sensitivity and type 2 diabetes are increasing rapidly in the population. They
are a particular concern in children and young adults where the long duration of the diabetes
can lead to earlier onset of associated conditions such as cataract and diabetic retinopathy.
There is a strong association with obesity, and prevention through weight control is seen as
probably the best management approach. There is also a link between obesity and
hypertension. Ocular manifestations range from earlier changes such as arteriosclerosis,
tortuosity and nipping of veins at crossovers, through to full hypertensive retinopathy with
vessel leakage leading to exudates and haemorrhaging.
A brief Overview on potential impacts of Eating Disorders
As you can see eating disorders can have a serious impact on the eyes as well as the rest of
the body. Parents need to understand the signs and symptoms of eating disorders so that they
can help their children to receive treatment as soon as possible. Eating disorders are a serious
condition and getting treatment will help those affected to discover the root of their problems
and work toward recovery. This is important as treatment can help to prevent death, serious
complications and permanent eye damage and vision loss.
i
ww.eyedoctorguide.com/eye_vitamin_nutrition/Eating-Disorders-and-Their-Impact-on-the-Eyes.html
http://www.nimh.nih.gov/health/publications/eating-disorders-new-trifold/index.shtml
iii
http://www.opticianonline.net/continuing-education/c40984-obesity-eye/?continuing-education=c40984obesity-eye&post_type=continuing-education
ii