Children with strabismus are at nearly two-folds higher risk of anxiety disorder, depressive disorder, schizophrenia or bipolar disorder compared to children who did not have the eye condition, according to a recent study published in JAMA Ophthalmology.¹

In this cross-sectional study from the United States, Lee et al set out to investigate the association between strabismus and mental disorders such as depression, anxiety disorder, substance use or addictive disorder, bipolar disorder, and schizophrenia. For this data from 12,005,189 patients with diagnosed strabismus was sourced from an insurance claims database between January 2007 through to December 2017. All participants were aged ≤18 years; their average age was 8 years and half of them were boys. A total of 352,636 children had strabismus; 11,652,553 children with no eye disease other than refractive error were selected as controls. The most common type of strabismus was esotropia (52.2%) followed by exotropia (46.3%) and hypertropia (12.5%).

Analysis of data showed a high association between strabismus and all mental disorders under study except for substance use disorder. Children with strabismus were twice as likely to have anxiety disorder (adjusted odds ratio 2.01). They also had higher risk of having depressive disorder with aOR 1.61, 1.83 for schizophrenia and 1.64 for bipolar disorder. However, no such association was noted for substance use disorder. The aOR for substance use disorder was 0.99.

When the types of strabismus were analysed, all of them were associated with increased odds of depressive disorder, anxiety disorder, bipolar disorder and schizophrenia. The OR was 1.23 for association between esotropia and bipolar disorder and 2.70 for the association between exotropia and anxiety disorder.

Strabismus is a common eye condition in children with immense psychosocial impact. This study provides an evidence-based, though modest, association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder. Hence, treating ophthalmologists should be aware of this association and be alert about symptoms of depression or anxiety in their patients with strabismus and timely refer them to psychiatrists for mental illness screening, even mild, and treatment. They should also educate the patients and their families or caregivers about the risk of mental disorders.

 Reference

1. Lee YH, et al. Association of strabismus with mood disorders, schizophrenia, and anxiety disorders among children. JAMA Ophthalmol. 2022 Mar 10. doi: 10.1001/jamaophthalmol.2022.0137.