THE CURIOUS CASE OF 'PSYCHO-OPHTHALMOLOGY': A NARRATIVE REVIEW OF OPHTHALMOLOGICAL ASPECTS OF PSYCHIATRIC DISORDERS.

Consultation Liaison Psychiatry (CLP) deals with the interface shared between psychiatry and various other disciplines of medicine. The interface shared by psychiatry and ophthalmology is among the lesser discussed ones in the field of CLP, despite the fact that it holds clinical relevance in the evaluation, management and outcomes of both psychiatric and ophthalmological disorders. This narrative review focusses on the ophthalmological aspects of psychiatric disorders, with respect to their manifestations, assessment, and management. Psychiatric disorders, including schizophrenia, affective disorders, 'functional' disorders, and substance use disorders, have numerous ophthalmic manifestations, which can have clinical implications for the patients. Even the psychotropic drugs given for psychiatric disorders can lead to side effects affecting the eye, but these are among the lesser-discussed side effects. Some psychiatric disorders can be investigated using various ophthalmic functions, the assessments ranging from simple physical examination to the use of instruments like a fundoscope, which can be useful for a psychiatrist in their routine practice. Lastly, eye functions can also be used in the treatment of psychiatric conditions, as is seen in eye movement desensitization and reprocessing. This review reiterates the fact that more attention needs to be given to the field of 'psycho-ophthalmology', which holds great promise in the coming days.

Occlusio Pupillae: A Duet of Darkness Where the Patient Sees Naught, and the Doctor Discerns Not.

A 71-year-old, one-eyed female patient presented with a loss of vision in the right eye due to trauma 20 years ago and a progressive diminution of vision in the left eye over the past six years. An ambiguous history of some surgery performed on the left eye was elicited, with no available records, adding an element of uncertainty to this case. Visual acuity (VA) was noted as no light perception (No PL) in the right eye and light perception with accurate projection of rays (PL+, PR accurate) in the left eye. Anterior segment slit-lamp evaluation of the right eye showed a shrunken globe with low intraocular pressure (IOP). The left eye exhibited signs of chronic uveitis with occlusio pupillae, non-visualization of the lens, and a doubtful conjunctival bleb with scleral thinning superior to the limbus. B-scan evaluation was suggestive of phthisis in the right eye and an equivocal lens shadow in the left eye. A yttrium aluminum garnet (YAG) pupillary membranotomy was planned for the left eye under steroid cover and was cautiously attempted, successfully detaching the occlusio membrane and revealing an underlying complicated cataract beneath it. Post-laser, medical management included topical anti-glaucoma and steroid medications, along with systemic steroids. The VA improved from PL+, PR accurate to 3/60 (improving to 6/60 with a Retinal Acuity Meter). After stabilization of the uveitis over the next few weeks and under a steroid cover, a temporal clear-corneal phacoemulsification was cautiously performed with intra-operative management of the small pupil, and a hydrophobic lens was implanted. At one month post-surgery, the patient's best-corrected visual acuity had improved to 6/12 for distance and N6 for near. This report highlights a compelling instance wherein the neodymium:Yttrium-aluminum-garnet (Nd:YAG) laser was efficaciously employed for a lesser-known application in resolving a diagnostic dilemma and for instituting an interim treatment strategy in a challenging case involving a one-eyed patient prior to planning a definitive surgery. This case emphasizes the importance of thinking out of the box, ensuring comprehensive preoperative and careful intra-operative precautions in the management of patients diagnosed with complex ocular inflammatory conditions, so as to optimize visual outcomes, eventually resulting in achieving a gratifying reduction of visual disability and improvement of quality of life.

Psychiatric aspects of ophthalmic disorders: A narrative review.

Ophthalmic disorders have psychiatric aspects associated with them at various levels. Psychological factors have a well-documented role in the causation, aggravation, and maintenance of various ophthalmic conditions, including glaucoma, central serous retinopathy, dry eye disease, and retinitis pigmentosa. Many ophthalmic conditions, including blindness, have psychological manifestations as well, which need to be addressed, in addition to the ophthalmic pathology. There is also significant overlap in the treatment of the two disciplines in many ways. For instance, many ophthalmic drugs have psychiatric side effects. Even ophthalmological surgeries have psychiatric aspects associated with them, which primarily include black patch psychosis and anxiety in the operation theater. This review will be useful for psychiatrists and ophthalmologists, for their clinical practice and research. Future research should focus on this interface to give it its well-deserved attention.