Can Antidepressants Cause Vision Troubles? Ophthalmologist Shares Hot Take

Antidepressants are a vital medication for millions of people battling chronic depression and anxiety. While these medications are often the saviour for many, responsible for stabilising mood, they can also cause unintentional side effects, including those affecting ocular health.

Although eye-related side effects induced by antidepressants remain a hushed topic, ophthalmologists say they are worth understanding. Being aware of potential problems can help patients protect their vision and seek prompt care if symptoms arise.

To outline the potential side effects of antidepressants on the eyes, OnlyMyHealth talked to Dr Anoop Mishra, Senior Consultant of Ophthalmology at Apollo Hospitals Lucknow.

Common Side Effects of Antidepressants on Eyes

Most medicines bear a list of possible side effects they can cause. As for the antidepressants, many patients experience temporary changes in their vision, like blurred vision, night blindness, vitreous floaters, photophobia, and visual field defect, soon after starting antidepressant therapy, concluded a study published by the National Library of Medicine.

According to Dr Mishra, “Some medications, like certain antipsychotics, can cause retinal damage. However, it is not frequent.” 

More common eye-related side effects seen in patients by Dr Mishra, after taking antidepressants include: 

• Dry eyes: Antidepressants can cause discomfort, burning, itching and a foreign body gritty sensation. It may cause redness and light sensitivity. This occurs because of the anticholinergic action, which decreases the secretion of the tear film's watery and mucus layers.
• Blurred vision: The anticholinergic effect of the medications dilates the pupils by causing paralysis of the iris sphincter muscle, which causes increased light sensitivity.
• Difficulty in focusing: Some medications act on the ciliary muscle and can impair its function, leading to blurry vision up close.

“Some antidepressants can increase the production of a fluid called aqueous humour that circulates in the eye. An increase in aqueous humour level can contribute to higher eye pressure, particularly because these medications also cause the pupil to dilate, which can lead to Angle Closure Glaucoma,” added Dr Mishra.

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Which Antidepressants Pose a Higher Risk to the Eyes?

Not all antidepressants carry the same eye-related risks. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are most commonly linked with ocular side effects. 

Tricyclic antidepressants (TCAs) such as Elavil can cause dry eye because they are anticholinergic. They inhibit the action of the neurotransmitter acetylcholine, which plays a role in the secretion of tears by the glands in the eyes, leading to dry eyes,” said Dr Mishra.

He added, “It causes a higher risk of increased eye pressure and Acute Angle Closure Glaucoma(AACG).”

Can Too Much Serotonin Affect Vision?

As per a Harvard study, too much serotonin may reduce the signals that eye nerves use to pass on visual information to the brain’s vision centre, known as the thalamus. This means the eye’s messages could get weakened before they even reach the parts of the brain that process what we see.

“Serotonin reuptake inhibitors work by slowing the reabsorption of serotonin, increasing its levels in the brain. Its imbalance can cause mild dry eyes and blurred vision due to dilatation of the pupil,” advised Dr Mishra.

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Could Side Effects of Antidepressants Be Permanent?

Antidepressant led side effects are often temporary and go away once the medicines are stopped. However, if the side effects are ignored for long, it can lead to more complications or even permanent damage. For example, untreated acute glaucoma can result in vision loss. 

Dr Mishra elaborates, “While most antidepressant-induced ocular side effects are mild and reversible upon discontinuation of the medication, some can lead to permanent vision changes if not addressed promptly,  specifically, acute angle-closure glaucoma.”

Who is At More Risk? 

People with Ocular dryness are more susceptible to the antidepressants’ side effects, which can further increase the dryness in the eyes.

“People with Pre-existing Angle Closure Glaucoma or Narrow angles are prone to attacks of Acute glaucoma, while on treatment with antidepressants, so they should visit their eye doctor regularly.”

How to Take Care of Antidepressant Side Effects 

“Preventive steps to protect their eyes while on Antidepressants are to use good lubricant eye drops, regular eye check-ups, maintaining a healthy lifestyle, avoiding sunlight and maintaining hydration,” advised Dr Mishra.

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Some Tips to Protect the Eyes

• Schedule regular eye exams, especially if you have preexisting eye conditions.
• Report any visual disturbances, such as sudden blurriness, pain, or halos around lights, to your doctor right away.
• Use preservative-free artificial tears to manage dry eyes
• Follow prescribed dosages carefully, and never stop antidepressants abruptly without medical supervision.

Conclusion: Precaution is Better Than Cure

Fighting with depression is already a challenge, so get yourself checked if medications give you additional eye problems. If you are on antidepressants and are facing issues with your eyes, it is best to visit your doctor and get the medications that work for you. While mental health should be your priority, your eyes should not be left behind.