Anemia is a result of an underlying condition and not a diagnosis. It occurs when there are not enough red blood cells or enough hemoglobin (protein in red blood cells that carries oxygen) to transport oxygen throughout the body. All cells require oxygen to function properly. Without it, they can rapidly deteriorate and die. Hemoglobin helps move oxygen throughout the body, and iron is the foremost essential component of this protein.
Worldwide, the most common cause of anemia is iron deficiency. Eyes can be impacted by anemia. If left untreated, the condition can lead to serious complications.
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Iron is necessary for the healthy production of hemoglobin to transport oxygen throughout the body. Signs and symptoms of IDA can typically include:
Fatigue and weakness
Dyspnea on exertion (the feeling of not being able to breathe deeply or get enough air during physical activity)
Causes of iron deficiency vary by age, socioeconomic status, and gender and can include the following:
Insufficient dietary iron intake
Impaired iron absorption (e.g., celiac disease or due to gastric surgery)
Increased iron loss due to bleeding (common in older patients, e.g., from hemorrhoids or other parts of the GI tract, or in women experiencing heavy menstrual periods)
Increased iron requirements, such as in young children or during pregnancy or lactation
Blood work and routine lab evaluations can easily identify iron deficiency anemia. Doctors commonly order a complete blood count or a CBC to check hemoglobin and ferritin levels.
If results are inconclusive or the underlying condition causing the anemia does not reveal itself, your doctor can also order additional testing, which can include:
Fecal occult blood test (checking for blood in the stool)
Endoscopy or colonoscopy (checking stomach, colon, and esophagus)
Barium enema or swallow (checking gastrointestinal tract)
Checking urine for blood
Gynecological evaluation for women experiencing heavy blood loss during periods
Bone marrow testing
The prognosis is excellent for most people diagnosed with iron deficiency anemia unless the underlying disease is serious, such as gastrointestinal cancer.¹
Treatment of iron deficiency anemia is hallmarked by oral iron supplementation as well as treatment of the underlying condition, if there’s one. Sometimes, it can be difficult to identify the cause.
Your medical provider may suggest you see a hematologist (specializing in blood disorders) for further evaluation. They may also recommend changing your diet to include iron-rich foods such as red meat, green vegetables, and iron-fortified bread and cereals.
Iron supplements (ferrous sulfate) are also beneficial and can take about three months to see results. The body will absorb the iron, helping hemoglobin levels rise as the bone marrow gets sufficient iron again.
Contact your doctor if you experience common side effects, including nausea, vomiting, and constipation.
Low iron levels can lead to problems throughout the body, including your eyes. The retina is the most vulnerable part of the eye and is susceptible to damage from iron deficiency anemia. The retina is the inside portion of the eye responsible for capturing images and sending the information to the brain. If the retina does not receive enough oxygen, the blood vessels behind the eye can become damaged, causing vision problems.
Iron deficiency anemia can also lead to central vein occlusion, retinal artery occlusion, or optic neuropathy. In extremely rare cases, it can also possibly lead to vision loss.
Hypoxia refers to low levels of oxygen in the body's tissues. Iron deficiency anemia can lead to retinal hypoxia, which can cause retinopathy, retinal edema, exudates, or vessel issues, along with hemorrhages. It is crucial to contact your medical provider at the first sign of symptoms to prevent permanent damage to your eyesight.
Retinopathy is also a concern for people with iron deficiency anemia. Studies show that retinopathy was observed in 28.3% of people with anemia.²
As the retina is sensitive to changes in oxygen, the more severe the anemia, the more severe the retinopathy will be. An eye doctor can identify the condition during a routine eye examination. However, you should contact your physician immediately if you experience any new issues with your vision.
Rarely, retinopathy can present with various vision disturbances or vision loss, but typically it’s asymptomatic.
A blood test is the most accurate way to diagnose anemia. Still, a routine eye examination can also raise suspicions of anemia due mainly to the paleness of the conjunctiva.
An ophthalmologist or any other doctor can pull down the eyelid and examine the vascular area of the eyes to check the color, which should be bright red. A pale white or pink color may indicate a low red blood cell count, a telltale sign of iron deficiency anemia.
When the eyes are dilated during an examination, an eye doctor can also look for bleeding and detect any portion of the eyes that are not receiving enough oxygen. Any problems with the blood vessels caused by a low iron supply can also be detected at this time.
A healthy eye will show a vibrant red conjunctiva when the eyelid gets pulled down, while that of an anemic individual will typically be pale with little to no color. This is a simple way for doctors to check for anemia before ordering a blood test.
The muscles and tissues in your body need oxygen to survive. Hemoglobin, which helps transport oxygen throughout the body, needs iron to be built. Iron is the main building block of hemoglobin, the core of the red blood cells, and essential to keeping the body alive.
Millions of people in the United States, especially young children and pregnant women, do not get enough iron.
Eyes and vision can be negatively impacted by iron deficiency anemia, leading to vision loss in extremely rare cases. When caught early, the condition is treatable with a daily intake of iron supplements, eating a healthy diet, and maintaining a healthy lifestyle.
It is not enough to treat only the symptoms of iron deficiency anemia. Identifying the underlying medical condition is essential to restoring adequate iron levels in your body for a full recovery.
Iron-deficiency anemia | American Society of Hematology
Dyspnea on exertion (2023)
Iron deficiency anemia (2023)
Anemic retinopathy: Case reports and disease features | Retina Today
Iron-deficiency anemia | American Society of Hematology
Evaluation of anemia | Merck Manual