[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [The eye in systemic disease](https://durgical.com/en/ophthalmology/areas/systemic/) › Eye signs that point to a systemic disease

# Eye signs that point to a systemic disease

- Eye and systemic disease

A ring in the cornea, a dislocated lens or spots in the retina can give away a systemic disease. Recognising them leads to the right test.

Updated Nov 5, 2026

**See it in 3D:** [Cornea](https://durgical.com/en/anatomy/cornea/) · [Lens](https://durgical.com/en/anatomy/lens/) · [Iris](https://durgical.com/en/anatomy/iris/) · [Retina](https://durgical.com/en/anatomy/retina/) · [Sclera](https://durgical.com/en/anatomy/sclera/)

## Key points

- Kayser-Fleischer = Wilson.
- Roth spots = endocarditis or leukaemia.
- Marfan up and out; homocystinuria down and in.
- Argyll Robertson = neurosyphilis.

## What it is

Some eye findings are characteristic of a systemic disease and can be the clue to its diagnosis. They are classic exam questions and useful in practice: a copper ring in the cornea, a white-centred retinal haemorrhage, a dislocated lens, blue sclerae or a cherry-red spot. The table links each sign to its disease and the next test.

## Eye findings

- Kayser-Fleischer ring: copper at the corneal edge in Wilson disease.
- Roth spots: white-centred retinal haemorrhages in endocarditis, leukaemia and anaemia.
- Lisch nodules: iris hamartomas in neurofibromatosis type 1.
- Blue sclerae: osteogenesis imperfecta.
- Corneal arcus before 50 or xanthelasma: check lipids.
- Band keratopathy: high calcium or chronic uveitis.

## Eye signs and the systemic disease behind them

| Sign | Think of | Next test |
| --- | --- | --- |
| [Kayser-Fleischer ring](https://durgical.com/en/conditions/wilson-disease/) | Wilson disease | Ceruloplasmin, urinary copper |
| Roth spots | Infective endocarditis, leukaemia | Blood cultures, echocardiogram, blood count |
| [Lens dislocated up and out](https://durgical.com/en/conditions/marfan-syndrome/) | Marfan syndrome | Echocardiogram (aortic root) |
| [Lens dislocated down and in](https://durgical.com/en/conditions/homocystinuria/) | Homocystinuria | Plasma homocysteine |
| [Lisch nodules](https://durgical.com/en/conditions/neurofibromatosis/) | Neurofibromatosis type 1 | Skin exam, genetics |
| Cherry-red spot in an infant | Lysosomal storage disease | Enzyme tests |
| [Lid retraction and lag](https://durgical.com/en/conditions/thyroid-eye-disease/) | Thyroid eye disease | Thyroid tests |
| [Argyll Robertson pupils](https://durgical.com/en/conditions/syphilis/) | Neurosyphilis | Treponemal serology, CSF |

## Screening and follow-up

- Argyll Robertson pupils are small, irregular and react to near but not to light.
- Angioid streaks (cracks in Bruch membrane) occur in pseudoxanthoma elasticum, Paget disease of bone and sickle cell disease.
- Conjunctival pallor suggests anaemia; scleral icterus, jaundice.

## Next step / Initial management

- Kayser-Fleischer ring or unexplained liver disease in a young person: ceruloplasmin and urinary copper, hepatology.
- Roth spots with fever: blood cultures and echocardiogram the same day.
- Dislocated lens without trauma: cardiovascular and metabolic workup and genetics.
- Lisch nodules or café-au-lait spots: neurofibromatosis assessment.

## Test yourself

Think of the answer, then tap the question to see it.

## What is a Kayser-Fleischer ring and which disease does it suggest?

A brown-green ring of copper at the corneal edge, in Wilson disease.

## What are Roth spots?

White-centred retinal haemorrhages seen in infective endocarditis, leukaemia and severe anaemia.

## In which direction does the lens dislocate in homocystinuria?

Downwards and inwards (inferonasally).

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/eye-signs-that-point-to-a-systemic-disease/)

## Connections

## See it in 3D 5

The structures of Durgical's 3D anatomy where it is found.

- [Cornea](https://durgical.com/en/anatomy/cornea/)
- [Lens](https://durgical.com/en/anatomy/lens/)
- [Iris](https://durgical.com/en/anatomy/iris/)
- [Retina](https://durgical.com/en/anatomy/retina/)
- [Sclera](https://durgical.com/en/anatomy/sclera/)

## Related 4

- [The lens and zonules through life](https://durgical.com/en/ophthalmology/the-lens-and-zonules-through-life/)
- [Sickle cell disease and the eye](https://durgical.com/en/ophthalmology/sickle-cell-disease-and-the-eye/)
- [Systemic infections in the eye: syphilis, TB, toxoplasma](https://durgical.com/en/ophthalmology/systemic-infections-in-the-eye-syphilis-tb-toxoplasma/)
- [Anisocoria: which pupil is abnormal](https://durgical.com/en/ophthalmology/anisocoria-which-pupil-is-abnormal/)

## Related conditions 6

- [Wilson disease](https://durgical.com/en/conditions/wilson-disease/)
- [Marfan syndrome](https://durgical.com/en/conditions/marfan-syndrome/)
- [Homocystinuria](https://durgical.com/en/conditions/homocystinuria/)
- [Neurofibromatosis (types 1 and 2)](https://durgical.com/en/conditions/neurofibromatosis/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)
- [Thyroid eye disease (Graves orbitopathy)](https://durgical.com/en/conditions/thyroid-eye-disease/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: [Kayser-Fleischer Ring](https://www.ncbi.nlm.nih.gov/books/NBK459187/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Roth Spots](https://www.ncbi.nlm.nih.gov/books/NBK482446/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Ectopia Lentis](https://www.ncbi.nlm.nih.gov/books/NBK578193/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Marfan Syndrome](https://www.ncbi.nlm.nih.gov/books/NBK537339/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ophthalmology/eye-signs-that-point-to-a-systemic-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/eye-signs-that-point-to-a-systemic-disease/