eMedicine Specialties > Ophthalmology > Metabolic Disorders

Hyperlipoproteinemia

Author: Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: Aug 14, 2007

Introduction

Background

Hyperlipoproteinemia is a metabolic disorder characterized by abnormally elevated concentrations of specific lipoprotein particles in the plasma.

Pathophysiology

Hyperlipidemia (ie, elevated plasma cholesterol or triglyceride levels or both) is present in all hyperlipoproteinemias. The primary form includes chylomicronemia, hypercholesterolemia, dysbetalipoproteinemia, hypertriglyceridemia, mixed hyperlipoproteinemia, and combined hyperlipoproteinemia. Other diseases, such as diabetes mellitus, pancreatitis, renal disease, and hypothyroidism, cause the secondary form.

Frequency

United States

This condition has a high frequency in developed countries.

Mortality/Morbidity

  • If uncontrolled, higher mortality occurs from cardiovascular and cerebrovascular diseases.
  • Abnormalities of the vascular system can develop, including ischemic cardiac disease. Obtaining appropriate medical evaluation is important, especially in patients younger than 40 years who have a prominent corneal arcus, xanthelasma, or lipemia retinalis.

Race

African Americans are affected more frequently than whites.

Sex

No sexual preponderance exists.

Age

Hyperlipoproteinemia may be present in children and young adults but is seen more frequently in later life.

Clinical

History

Clinical manifestations of the hyperlipoproteinemias are caused by the deposition of lipids in the vascular system and the eye.

Physical

  • Corneal arcus, lipemia retinalis, and xanthelasma are the most common ocular abnormalities.
  • Lipemia retinalis is primarily caused by an elevation of the serum triglyceride levels, which imparts a milky color to the blood.
    • The changes are usually not seen until the triglyceride level reaches at least 2000 mg/dL in the early stages; they are best observed in the peripheral fundus. The vessels initially appear salmon-pink, but, when the triglyceride level rises further, they become whitish.
    • These changes, which begin in the periphery, progress toward the posterior pole as the triglyceride level rises. In severe cases, the vessels are creamy white, and differentiating the arteries from the veins is difficult. The findings can fluctuate widely from day to day, depending on the triglyceride level.
    • The fundus abnormalities, which improve as the triglyceride levels return to normal, provide a method of following the patient's course and response to therapy.
  • Xanthelasma is a deposition of lipid in the eyelid, usually the upper medial lid. The lesions may be excised, but recurrences are common. With primary excisions, recurrences of up to 40% have been reported, and secondary excision recurrences are even higher. Of the initial failures, 20% are within the first year.

Causes

Risks appear to include diet, stress, physical inactivity, and smoking.

More on Hyperlipoproteinemia

Overview: Hyperlipoproteinemia
Differential Diagnoses & Workup: Hyperlipoproteinemia
Treatment & Medication: Hyperlipoproteinemia
Follow-up: Hyperlipoproteinemia
References
[ CLOSE WINDOW ]

References

  1. Bron AJ. Corneal changes in the dislipoproteinaemias. Cornea. 1989;8(2):135-40. [Medline].

  2. Brownstein S, Jackson WB, Onerheim RM. Schnyder's crystalline corneal dystrophy in association with hyperlipoproteinemia: histopathological and ultrastructural findings. Can J Ophthalmol. Aug 1991;26(5):273-9. [Medline].

  3. Crispin SM. Lipid deposition at the limbus. Eye. 1989;3 (Pt 2):240-50. [Medline].

  4. Feldman EB. Nutrition and diet in relation to hyperlipidemia and atherosclerosis. In: Shields M, Olson JA, Shike M. Modern Nutrition in Health and Disease. 8th ed. 1992.

  5. Gronemeyer A, Arsene S, Le Lez ML, Rateau J. [Central retinal artery occlusion or branch retinal artery occlusion in the young associated with high lipoprotein (a) levels]. J Fr Ophtalmol. Sep 2002;25(7):727-30. [Medline].

  6. Jünemann A, Küchle M, Naumann GO. Epithelial iron line in juvenile corneal arcus lipoides. Cornea. Sep 1995;14(5):540-2. [Medline].

  7. Wu CW, Lin PY, Liu YF, Liu TC, Lin MW, Chen WM, et al. Central corneal mosaic opacities in Schnyder's crystalline dystrophy. Ophthalmology. Apr 2005;112(4):650-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hyperlipidemia, chylomicronemia, hypercholesterolemia, dysbetalipoproteinemia, hypertriglyceridemia, mixed hyperlipoproteinemia, combined hyperlipoproteinemia, high cholesterol

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

James P Gills, MD, Founder, St Luke's Cataract and Laser Institute; Professor, Department of Ophthalmology, University of South Florida College of Medicine
James P Gills, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.