Volume 4 Issue 10 Oct 2014
Eyes are the windows of soul. Various factors like holding of the gaze, frequency of blinking and the change in pupil
size have all being linked to the attention and interest with which a person looks at something.
One of the first things assessed by the psychiatrist which demonstrates the link between eye and psychiatry is an ‘eye
contact’. Patients often break off eye contact while talking about issues which when probed turn out to be important
stressors hidden by the patient during the interview. Also in pervasive developmental disorders like autism there is
lack of eye to eye contact.
Many psychiatric conditions have ophthalmic manifestations. Schizophrenia patients have trouble in smooth pursuit
movements (jerky movements of the eye known as saccades while following a moving object), gaze fixation, reduced or increased eye blinking. Visual hallucinations occur in delirium, mania and also in socially isolated people. Drug abuse (eg- hallucinogen like LSD) leads to visual hallucinations in the acute as well as later in the form of flashbacks. In the past, following the placement of patch after cataract surgery, patients developed delirium and hallucinations also called ‘black patch psychosis’.
Anxiety disorders especially post traumatic stress disorder show disordered eye movements. Eye movement
desensitization and reprocessing is a therapy targeted at relief of these symptoms. Eyes are often targeted in selfmutilation with or without any psychiatric disorder-ranging from scars on eyelids (due to branding with a hot object
on the face) to pulling out of eyeballs.
Various mental retardation syndromes like congenital metabolic syndromes like Lawrence moon Biedl syndrome, Ushers syndrome, Bassen kornweig syndrome, Refsums syndrome, and Alstrom syndrome etc. have variety of ophthalmic manifestations. Other genetic disorders associated with mental retardation like Down’s syndrome,
WAGR syndrome also show much of psychiatric morbidity along with ophthalmic symptoms. Charles Bonnet
syndrome occuring in the elderly is manifested by visual pseudo hallucinations and is due to intracerebral pathology.
Wilson’s disease (hepatolenticular degeneration) features emotional lability, impulsive behavior, frontal lobe
disorder, subcortical dementia, depression, anxiety and psychosis along with KF ring and sunflower cataract.
Blepharospasm which is forcible closure of the eyelids in the form of a tic or twitch can be seen in psychiatric
conditions like Tourette’s syndrome and tardive dyskinesia. Certain ophthalmic signs helps to differentiate between
functional and organic symptom, eg., Dolls eye movement and caloric tests. Fundus examination is an integral part
of psychiatric examination to rule out intracranial hypertention.
Certain psychotropic drugs like Chlorpromazine and thioridazine cause lenticular opacification, retinopathy, ocular
dystonias, accommodation & mydriasis. Lithium causes apraxia of eyelids, blepharospasm and dystonias. Tricyclic
antidepressants cause blurred vision and angle closure glaucoma. Topiramate causes angle closure glaucoma,
dystonia and acquired myopia. Carbamazepine causes dystonia and impairment of colour vison. Benzodiazepines
cause dystonia, loss of convergence and color indiscrimination.
Considering this close knit relation, any patient presenting with psychiatric symptoms, one should also look for
ophthalmic manifestation as a part of a holistic approach.
Dr.Manamohan N., Dr. Sujoy Ray, Dr.Priya Sreedharan, Dr.Ashok. M. V.
Department of Psychiatry, St. Johns Medical College & Hospital, Bangalore.
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