Psychiatric illnesses and ophthalmic disorders can be associated in three different patterns: (a) psychiatric diseases causing ophthalmic disease; (b) ophthalmic diseases causing emotional stress and related mental health issues; and (c) ophthalmic conditions with strong associations with psychiatric diseases.

Trichotillomania (compulsive eyebrow and eyelash pulling), ocular manifestations of Münchhausen syndrome (self-inflected injuries) or Münchhausen syndrome by proxy (factitious disorder by proxy), and functional visual disorders are examples of ocular manifestations of mental health disorders. Functional visual disorders include blinking, vision loss, eyelid pulling, and photophobia. Functional disorders may be signs of significant stress in the home including covert physical, emotional, or sexual abuse. Malingering and functional hysteria may also present with ophthalmic symptoms. Patients with visual loss and a completely normal examination can also have other organic ophthalmic diseases including Stargardt disease, autosomal dominant optic atrophy, optic neuritis, and retinal degenerative disorders. In addition, patients with psychiatric illnesses tend to be less compliant with treatment.

Significant emotional stress can occur with patching therapy, visual impairment, and cosmetically significant strabismus, ptosis, or globe disfigurement. These emotional factors can lead to the potential for mental health symptoms, and it is important for the pediatric ophthalmologist to recognize and minimize these risk factors.

Several ophthalmic disorders have an associated psychiatric illness. Alagille syndrome (Chapter 17: Gastrointestinal) and Wolfram syndrome (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness) are examples.