Sara Fatima Memon¹, Shahid Iqbal², Kashaf Zaidi³

1. University Hospitals Dorset NHS Foundation Trust
2. The Hillingdon Hospitals NHS Foundation Trust
3. Bart’s and the London, School of Medicine and Dentistry

Psychiatric inpatients represent a unique population with distinct healthcare needs, particularly concerning ocular health. Often grappling with severe mental health challenges, these individuals face an elevated risk of developing physical health conditions which can significantly impact their quality of life.

The intersection of mental and ocular health in psychiatric inpatients is a relatively under-explored area. Studies, albeit few, have pointed out that individuals with severe mental illness are more susceptible to visual impairment and symptoms such as blurred vision, headaches and periocular pain (1). Notably, psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects (2). Disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium, whilst uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs) (2). Problems with accommodation are related to TCAs and to low-potency antipsychotics, with TCAs causing transient blurred vision in up to one-third of patients (2,3). Cataractous changes can result from antipsychotics, mainly from high doses of chlorpromazine or thioridazine (4,5). Other visual problems of special concern are the ocular dystonias (particularly with high potency antipsychotics) and decreased ability to perceive colours and to discriminate contrast(2).

Factors such as reduced access to regular eye care, financial constraints, and the lack of awareness about the importance of ocular health in this group also contribute to the higher incidence of eye problems. One of the primary hurdles is the difficulty in follow-up and consistent treatment. This challenge stems from various factors, including the patients’ limited ability to recognize or communicate their symptoms effectively, and a compromised decisional capacity (6). Symptoms such as delusions or hallucinations can overshadow or be mistaken for visual disturbances, leading to misdiagnosis or delayed treatment (7). Moreover, there is a lack of integrated care between mental health and ophthalmology services (8). This separation can create barriers for patients, who may require coordinated care to address their needs effectively, particularly when considering the stigma associated with mental illness and the logistical challenges of transporting inpatients for external consultations.

When considering these logistical difficulties, assessing eye health during long inpatient stays offers a unique opportunity to improve overall patient care. Improved visual acuity can aid in the rehabilitation process by enabling patients to engage in activities aimed at promoting mental health. It can serve as a form of holistic care, demonstrating a commitment to treating the individual as a whole. The link between sensory health, particularly vision, and overall well-being is well-established: vision being a key sensory perception that significantly influences our interaction with the world. Impaired vision can lead to social isolation, difficulty in navigating environments, and a decreased ability to perform daily tasks, all of which are barriers to effective recovery in patients with serious mental illness. Studies have shown a strong correlation between visual impairment and mental health issues such as depression and anxiety (8–10). One study found that self-reported visual loss was significantly associated with depression (11).

Considering the prevalence of ocular conditions in this population and recognizing the profound impact of sensory health on overall well-being may allow healthcare providers to offer more comprehensive and effective care, contributing to the holistic well-being and rehabilitation of patients with serious mental illness in hospital.

References

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