Strabismus Associated With Multiple Psychological Disorders

Little boy making eyes strabismus
Little boy making eyes strabismus
Clinicians should consider counseling children with strabismus and their caregivers on their possible predisposition to mental illness.

Strabismus may be associated with anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder, according to a study published in JAMA Ophthalmology.

The investigators enrolled 12,005,189 children (50.8% boys) from a collaborative research database dating from 2007 to 2017 in the study. They compared mental illness diagnoses between children with strabismus (n=352,636, mean age 8.0±4.5 years) and age-matched controls (n=11,652,553, mean age 8.0±5.9 years).

The team determined that children with strabismus were more likely to have mental health diagnoses compared with their peers in the control group, including anxiety disorder (OR=2.01, 95% CI, 1.99-2.04), depressive disorder (OR=1.61, 95% CI, 1.59-1.63), bipolar disorder (OR=1.64, 95% CI, 1.59-1.70), and schizophrenia (OR=1.83, 95% CI, 1.76-1.90).

Overall, 11.6%, 8.0%, 1.2%, and 0.8% of patients with strabismus received a diagnosis of anxiety disorder, depressive disorder, bipolar disorder, and schizophrenia, respectively, compared with 6.4%, 6.3%, 0.9%, and 0.5% in the control group. Researchers noted no associations between strabismus and substance abuse.

Investigators express concern that children with strabismus may not be accessing appropriate mental health care. “These results should alert ophthalmologists and optometrists to counsel children and their caregivers regarding the risk for mental illness. They should consider incorporating a screening tool for mental health problems for patients with strabismus and referral of pediatric patients with strabismus for mental health evaluation.”

Limitations of the study include a potential for coding errors given the massive amount of data and failure to include patients with no insurance or government insurance.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Lee YH, Repka MX, Borlik MF, et al. Association of strabismus with mood disorders, schizophrenia, and anxiety disorders among children. JAMA Ophthalmology. Published online March 10, 2022. doi:10.1001/jamaophthalmol.2022.0137