Last updated: 23/4/20

Beyond self-care as professionals, mental health awareness also has a large role to play in the management of our patients’ well-being. As you start seeing more patients, you will realise that optometry is more than just eye health and glasses.

Examples of managing mental health in clinic:
  • Patient seeks reassurance/advice for another optometrist's clinical findings
  • Breaking bad news to the patient and their family regarding their vision
  • Patient is concerned about COVID-19 and/or fears regarding a lack of PPE
  • Ocular side effects of antidepressants, medications prescribed for mental health
  • Associated side effects of mental health disorders
  • Referring patients to the GP or professionals who can provide mental health support

 Mental health disorders often manifest alongside ocular signs and symptoms
According to the World Health Organisation, you are 3x more likely to suffer from depression and anxiety disorders if you are visually impaired. There is evidence to show a link between depression and dry eye symptoms [1]. Low vision patients with severe cataracts or ocular diseases such as ARMD and glaucoma are also all at much higher risk of developing depression and reduced social independence as a result of their vision loss [2]. Recognising these issues allows us to suggest proper help through services such as Vision Australia and Guide Dogs Australia.

Anorexia Nervosa, a condition characterised by a distorted body image and excessive fear of weight gain, may also manifest as changes to ocular function. In some cases, patients with severe Anorexia have been found to show oculomotility dysfunction associated with ocular changes due to Wernicke's encephalopathy, an acute and potentially fatal neuropsychiatric syndrome caused by severe thiamine deficiency [4]. Another retrospective case series also reported lagophthalmos among five patients with severe Anorexia, however these findings have been rare and not well documented in literature [5].

Common side effects of medications for mental health disorders [3,6,7]
(e.g. TCAs, SSRIs)
  • pupil dilation
  • blurred vision
  • binocular vision abnormalities
  • inducing angle-closure glaucoma
  • impaired cognition
  • headaches
  • impaired motor function

When we triage the patient during history taking, knowing about these side effects can help us organise our consultation and management plans.

Great articles about the ocular side effects of antidepressants and mechanisms of action:

Link to our page on 'Mental Health First Aid'
Link to resources and helplines for managing mental health


 References
1. Zheng, Y., Wu, X., Lin, X. and Lin, H., 2017. The prevalence of depression and depressive symptoms among eye disease patients: a systematic review and meta-analysis. Scientific reports, 7, p.46453.
2. Economics, A., 2020. Clear focus: the economic impact of vision loss in Australia in 2009. An Overview of the Report Prepared for Vision.
3. Peretti, S.J.R.H.I., Judge, R. and Hindmarch, I., 2000. Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatrica Scandinavica, 101, pp.17-25.
4. Oudman, E., Wijnia, J.W., Oey, M.J., van Dam, M.J. and Postma, A., 2018. Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review. Psychiatry and clinical neurosciences, 72(10), pp.774-779.
5. Gaudiani, J.L., Braverman, J.M., Mascolo, M. and Mehler, P.S., 2012. Ophthalmic changes in severe anorexia nervosa: a case series. International Journal of Eating Disorders, 45(5), pp.719-721.
6. Leat, S.J., Chan, L.L.L., Maharaj, P.D., Hrynchak, P.K., Mittelstaedt, A., Machan, C.M. and Irving, E.L., 2013. Binocular vision and eye movement disorders in older adults. Investigative ophthalmology & visual science, 54(5), pp.3798-3805.
7. Richa, S. and Yazbek, J.C., 2010. Ocular adverse effects of common psychotropic agents. CNS drugs, 24(6), pp.501-526.