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Looking for a link between strabismus and mental health concerns

Is there a connection between strabismus and mental health concerns like bipolar disorder? A recent study provides insight.

Vision issues can have a number of effects on a child’s life, from making learning difficult to exacerbating headaches. An investigation examines whether there is a connection between mental illness and strabismus.1

The investigators ran a cross-section study that analyzed claims data from a longitudinal deidentified commercial insurance claims database to find patients who were enrolled in a health plan between January 2007 and December 2017. The eligibility criteria for inclusion were age younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes. These children were compared to controls in the database who had no codes for eye disease, excepting refractive errors.

The cohort included 12,005,189 patients with an average age of 8.0 years. The investigators tabulated the adjusted odds ratios for the link between mental illness and strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for substance use disorder. A moderate link between the 3 strabismus types: esotropia, exotropia, and hypertropia, and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder were noted. The odds ratio for these moderate links ranged from 1.23 (95% CI, 1.17-1.29) for the link between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for exotropia and anxiety disorder. However, no association was noted for substance use disorder and strabismus.

The investigators concluded that a link did exist between many mental health concerns and strabismus. They urge clinicians to be diligent in mental health screenings in patients who have the condition.


1. Lee Y, Repka M, Borlik M, et al. Association of strabismus with mood disorders, schizophrenia, and anxiety disorders among children. JAMA Ophthalmol. March 10, 2022. Epub ahead of print. doi:10.1001/jamaophthalmol.2022.0137