Anemia can damage tissue in the eye, causing a range of symptoms. These might include discoloration, pale eyelids, hemorrhages, and eye test findings called cotton wool spots and Roth spots.

Anemia occurs when the body cannot produce enough healthy red blood cells (RBCs). This typically occurs due to a shortage of hemoglobin, a protein that attaches to oxygen and carries it to tissues across the body. People often develop anemia due to a shortage of iron, and it can also result from vitamin deficiencies, other diseases, or bone marrow problems.

The lack of oxygen causes a range of symptoms, including weakness, breathlessness, and dizziness. However, anemia can also cause several signs and issues in the eyes.

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When anemia affects the eyes, it is often known as anemic retinopathy. This refers to damage to the retina of the eye due to anemia. According to a 2023 study, this is a common effect of severe anemia. However, the exact cause is not clear. Anemia may change and damage the blood vessels of the cell layer at the back of the eye called the retina.

The study maintains that not enough evidence is available to determine how common anemic retinopathy is and how closely it may relate to the severity of anemia.

Some types of anemia, such as sickle cell anemia, can thin the retina. This might lead to the following eye symptoms, according to the American Society of Retina Specialists:

  • blind spots
  • floaters
  • blurred vision
  • light flashes
  • loss of vision at the outer edge of the visual field

The possible eye symptoms of anemia include the following.

Blue or yellow sclera

The sclera is the outer layer of the eye’s whites, and anemia may cause it to become blue. A 2022 review concluded that it is much more common in people with iron deficiency anemia — the most common type of anemia — than in other forms.

This might develop due to the thinning effects of anemia on the sclera’s collagen fibers, meaning that the blue layer underneath, the uvea, becomes more visible.

Anemia can also cause jaundice, or yellowing of the skin and sclera. Jaundice develops when the liver does not break down enough bilirubin, a yellow substance, leading to a buildup of bilirubin in the body.

Pale eyelids

The lining of the eyelids, or palpebral conjunctiva, is usually red or dark pink in people with healthy RBCs. However, people with anemia might find that the lining of the inner eyelid is paler than expected when they pull down the lower eyelid.

Cotton wool spots and Roth spots

Cotton wool spots look like slightly raised lesions with a cloudlike outline. They are small and yellow, white, or gray, possibly occurring due to blocked blood vessels in the retina. Cotton wool spots often do not cause any visual symptoms, but they can affect vision if the spots occur on a central part of the retina called the fovea.

Roth spots are hemorrhages with a white center that show up during an eye exam. They occur due to clotted blood that has leaked from blood vessels in the retina.

Transient retinal hemorrhage and edema

Blood leakage in different layers of the retina can highlight anemia. This might occur when low oxygen levels in the eye damage the retina’s blood vessels, causing the vessel walls to break and leak. Retinal hemorrhage may also lead to a buildup of fluid and swelling on the retina, known as retinal edema.

Anemia may not cause symptoms until it reaches an advanced stage. However, it may lead to the following symptoms:

  • bleeding
  • breathing difficulties
  • chills
  • dizziness
  • fainting
  • fatigue
  • headaches
  • jaundice
  • pale skin
  • weakness

Depending on the underlying cause, anemia may develop rapidly or slowly. However, symptoms are similar among people with many different types of anemia.

A doctor can diagnose anemia with several blood tests followed by bone marrow testing. The blood tests measure the following:

  • RBC count
  • hemoglobin levels
  • levels of hematocrit, or the amount of space RBCs use in the blood
  • mean corpuscular volume (MCV), which measures the size of the RBCs

Results from blood tests may then lead to bone marrow aspiration and biopsy. This involves collecting bone marrow fluid through a large needle and examining it under a microscope. As the bone marrow produces RBCs, this may demonstrate the cause of a type of anemia.

Anemia eye symptoms often resolve when a person treats the underlying cause of their anemia, per a 2022 case study. The treatment varies depending on the cause but might include:

  • certain medications to support RBC production in the bone marrow or suppress the immune system if an autoimmune disorder is responsible for the anemia
  • dietary supplements for those who have anemia due to a nutrient deficiency, such as iron or vitamin B12
  • blood transfusion, in which a person receives donated blood with healthy RBCs to reduce severe complications of anemia
  • blood and bone marrow transplantation, in which a doctor uses healthy stem cells to replace faulty stem cells that create blood

Preventing all types of anemia is not possible. However, some, such as iron deficiency anemia, are preventable through the diet. People can reduce their risk of iron deficiency anemia in the following ways, according to the World Health Organization:

  • eating high iron foods, such as lean red meat, fish, poultry, lentils, beans, leafy green vegetables, and fortified cereals
  • eating foods with good vitamin C content, including fruits and vegetables, which supports iron absorption
  • reducing intake of foods that lower iron absorption, such as coffee, tea, cocoa, those containing bran, and high calcium foods
  • taking iron and calcium supplements at different times of day if those are necessary to address certain deficiencies
  • consulting a doctor about heavy menstrual periods, which can lead to iron deficiency anemia
  • thoroughly washing the hands with soap and water and using clean toilets where possible to avoid anemia-linked infections

Severe anemia can lead to retinal damage, which may cause eye symptoms, including discolored sclera, cotton wool or Roth spots, transient retinal hemorrhage, edema, and pale eyelids. Some types of anemia, such as sickle cell anemia, might contribute to vision loss.

Anemia’s eye symptoms often reverse once a person addresses the underlying cause. Treating anemia might involve medications, supplements, blood transfusions, or surgery.