1. The most obvious ocular health concern that you'll spot is at the macula.  See those yellow color distortions right in the center?  Those are drusen consistent with dry age related macular degeneration.  This patient came in for her annual exam with a known history of AMD that was being followed, so this macular appearance was expected.  But can you see the new issue?

2. Follow the artery (the lighter colored blood vessel) up from the optic nerve and you'll come to a whitish round circle smack in the middle of the artery wall.  This is a cholesterol plaque lodged in the arteriole, called a Hollenhorst plaque.  Luckily you can see blood passing through the artery to the other side.  If the blood vessel is white on the other side of the artery we know we have full obstruction and this would be an artery occlusion instead of just a plaque (occluded arteries are much more serious!).  A cholesterol plaque, even when there is blood passing around it, is still a potentially serious threat to vision and systemic health; if there's a blockage in your eye there is likely a risk for cholesterol blockages elsewhere too.

What You Need to Know
Cholesterol blockages or Hollenhorst plaques are often found without causing any vision symptoms, so this is just one more reason why routine ocular health checks with dilation or imaging is a vital part of everyone's preventative health care.  The patient above had absolutely no vision complaints, and unless blood flow is being blocked, likely there will be no affect on vision. If there is a plaque limiting blood flow to the retinal tissue, the patient will likely experience blacking out of vision (called amaurosis fugax or transient ischemic attacks) that can last for minutes at a time. Any sudden vision loss is always worth a call to your eye doctor, even when it is painless!

via

There is no active treatment for Hollenhorst plaques in the exam chair, but finding the cause of the blockage is the first line of action. Studies suggest between 45-55% of patients with Hollenhorst plaques have significant carotid stenosis (blockage) of the internal carotid artery on the same side as the affected artery.  Your doctor will order a carotid doppler or ultrasound to detect the presence of stenosis.  If you have been diagnosed with conditions like high cholesterol, high blood pressure, diabetes, or are a smoker you are at a much higher risk of getting these cholesterol blockages due to chronic damage to your artery walls. The carotid artery is particularly at risk for cholesterol plaque blockage because it splits into multiple branches right as it enter the base of the skull.  The split into smaller passageways creates an area for cholesterol plaques to get lodged, constricting blood flow through the area.  The carotid artery is very dangerous to occlude though -- it's delivering blood not just to your eye but to your brain so a blockage here could put you at risk for serious health issues and even a stroke.

If your doctor finds carotid stenosis on your ultrasound, it will likely be treated with oral medications like anti-platelet/blood thinners (baby aspirin is a common one) and cholesterol lowering medication like the statin category of meds.  Surgical treatment is sometimes required to remove the obstruction -- typically when the carotid is > 60% stenosed surgery is the preferred treatmetn method. 

Optos retinal imaging showing a Hollenhorst plaque via

By The Numbers
While you might not notice any problems or changes in your vision, if a Hollenhorst plaque is found during your eye exam it's not to be taken lightly.  The Beaver Dam Eye Study found that those with Hollenhorst plaques or any retinal emboli were at a 3 x higher risk of fatal stroke over the next 8 years.  This is a finding not to be ignored, and just another reason that when you go to your eye doctor, you need to have retinal imaging and or dilation done every single year, even if you don't notice any problems with your vision.  An eye exam is a snapshot of your entire systemic health, and using the retina like a window into your body's inner workings can save your life.

Have you had your systemic health checked lately?  For many people, the answer is no.  Luckily if you are getting routine eye exams, your eye doctor can detect early signs of systemic health issues like high cholesterol!  How can I see potential cholesterol issues in your eye?

Corneal Arcus: that ring of blue is really cholesterol! photo via studyblue.com

1) Corneal Arcus

Have you ever noticed a faint white or bluish ring that appears to be around the iris (the pigmented part of the eye)?  I have even had patients come in stating that they think their brown eyes are turning blue because they see this change in the mirror.  Nope, your eyes are not getting bluer; they are getting more cholesterol-y. Arcus is a ring of cholesterol deposition in the cornea (the clear dome that lays over the iris).  In the elderly, this is typically a normal change, and does not necessarily mean you have high cholesterol issues.  If we see these changes in young patients (under 40), however, cholesterol levels should be checked!

2) Arteriosclerotic Changes

When your eyes are dilated or your retina is alternatively evaluated, your doctor is paying close attention to your retinal blood vessels.  The arteries in the eye (really arterioles because they are too small to be arteries technically) will express the same health changes that arteries in the rest of your body are undergoing, making the eye a great place to assess vascular health.  High cholesterol can cause hardening of the artery (causing a whitened artery appearance instead of the normal red). In more severe cases, there can even be plaques of cholesterol that block or limit blood flow.  This can even cause vision loss in severe cases.  If arteriole changes are noted, your doctor will suggest checking blood pressure, cholesterol, and other vascular issues and may even send a note with their findings to your primary care doctor.  In many cases, these changes may not have any visual symptoms, making their detection completely dependent on you getting a health examination.

Lipemia Retinalis:  severe whitening of the retinal vessels due to elevated cholesterol photo via doctorshangout.com

A Hollenhorst plaque is a blockage of cholesterol that lodges within the retinal vasculature and obstructs flow via

3) Xanthelasma

Cholesterol can also build up as plaques on the eyelids, typically on the nasal aspects of the lid.  These areas look like elevated yellowish growths.  They can be removed by a surgeon, but may return if cholesterol levels remain uncontrolled.

Xanthelasma plaques via dermis.net

Interested in learning more about how high cholesterol affects your entire body's health?  Check out this interactive resource from Healthline where you can learn more about cholesterol's toll on individual organs and body parts.  You can also head here to see what 100% of your daily value of cholesterol looks like.  Remember, your eye is a part of your body, and even if you don't have vision problems a yearly eye exam can help detect serious systemic health issues like elevated cholesterol, high blood pressure, and diabetes that could mean the difference in a happy, healthy life.