Many diseases that affect the health of the body as a whole can damage the eyes or cause changes in the eyes that doctors and optometrists can detect. The best known of these are probably diabetes and high blood pressure, but there are others.

One that is often overlooked is xanthelasma (plural xanthelasmata). Some people are prone to develop small yellowish lumps on the skin of the eyelids that are due to the accumulation of cholesterol (photo). They are known to occur in people with high blood cholesterol (hypercholesterolemia or hyperlipidemia), but also occur in people whose cholesterol levels are normal. If a patient’s cholesterol level is normal then xanthelasmata have usually been considered a cosmetic blemish only, that are easy to treat by excision. The true importance of them has been unclear until now. 

A major study from Denmark published last month in the British Medical Journal (BMJ) showed that whether or not a patient’s cholesterol level was high, having xanthelasmata was associated with an increased risk of ischemic heart disease and heart attack, severe atherosclerosis and death. 12,745 people were followed from 1976-8 until 2009 (the average follow-up time was 22 years), making this the largest study so far to look at this issue.

The explanation for why xanthelasma is an independent risk factor for atherosclerosis and heart disease is not clear, but it is likely that people with xanthelasma have a greater tendency to deposit cholesterol in tissues of the body than people without them, regardless of the actual level of cholesterol in the blood. People with xanthelasmata may benefit from lifestyle changes to reduce other cardiovascular risks, and may benefit from treatment to lower so-called “bad” cholesterol (low density lipoprotein or LDL).

Xanthelasma is easily diagnosed without special equipment, so it doesn’t need a visit to an optometrist or ophthalmologist, but we now know that when GPs, optometrists, ophthalmologists or dermatologists notice it, it’s significance is more than skin-deep.

(M Christofferson et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ 2011; 343.)