Ocular Manifestations and Endothelial Cell Density in Chronic Liver Disease Patients and Its Corelation with Severity of Liver Disease

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Introduction: Liver disease, whether congenital or acquired, can result in several manifestations in the eye. Various forms of liver disease including hepatitis C and autoimmune hepatitis have also been linked to several ocular manifestations. The ocular manifestations of cirrhosis include xerophthalmia, Vitamin A deficiency, and color blindness. The present study aimed to identify various ocular manifestations in cirrhosis particularly retinopathy and their relation to cirrhosis severity. Materials and Methods: This cross-sectional observational study included 100 consecutive cirrhotic patients. The severity of liver disease was assessed by Child–Pugh score. Detailed ophthalmologic examination including vision test, color vision, intraocular pressure measurement, Schirmer test, corneal endothelial cell density, and fundus examination was done. Results: The mean age of all patients was 44.3 ± 10.2 years. Forty-eight (48%) patients had Child-Pugh Class A, 29% Class B, and 23% Class C category. The most common etiology of cirrhosis was alcohol (56%) followed by hepatitis B (18%). Prevalence of xerophthalmia was more in Child–Pugh Class B (27.6%) and Class C (26.1%) as compared to Class A (12.5%). The mean endothelial cell density was also significantly ( P < 0.001) less in Child–Pugh Class C cirrhosis (2105.2 cells/mm 2 ) as compared to Class B (2312.6 cells/mm 2 ) and Class A (2501.4 cells/mm 2 ). Night blindness was significantly ( P < 0.001) more in Child–Pugh Class C cirrhosis (56.5%) as compared to Class B (6.9%) and Class A (0%). Retinopathy was also found to be significantly ( P < 0.001) more in Child–Pugh Class C cirrhosis (60.9%) as compared to Class B (13.8%) and Class A (12.5%). Conclusion: Ocular manifestations are common in patients with liver disease. Fundus abnormalities in the form of yellowish-white dots in the retinal mid periphery are more common in severe (Child C) liver disease. The mean corneal endothelial cell density is also significantly low in Child Class C cirrhosis. A high index of suspicion and early Vitamin A supplementation may reduce ocular morbidity.