OCULAR ABNORMALITIES IN CHRONIC-SCHIZOPHRENIA - CLINICAL IMPLICATIONS

Objective: As part of a randomised double-blind study of a new atypica l antipsychotic we sought to determine both the levels of visual acuit y and the occurrence of toxic side-effects in a group of patients trea ted for many years on a variety of antipsychotics. Method: Twenty-thre e inpatients with a DSM-III-R diagnosis of chronic schizophrenia from two separate hospital locations who met the criteria for the double-bl ind trial were examined for ocular abnormalities at both baseline and at trial completion. Results: At baseline a high prevalence of abnorma lities was identified: 19 patients (82.6%) were found to have one or m ore ocular abnormalities, including lens opacities/cataracts and corne al pigmentation; three patients, with delusions related to the sun, we re noted to have solar burns; a high proportion (almost 70%) of patien ts had untreated visual acuity problems. No further changes were obser ved at the follow-up examinations. Conclusions: The possible causes of ocular disturbance in schizophrenia and the reasons for the relativel y high ocular morbidity in this group are thought to result from both illness-related factors and the effects of antipsychotic medication. C ausality is confounded by a number of issues such as the high prevalen ce of smoking, poor general health and the variety of antipsychotic me dications used in the treatment of psychosis as well as substance abus e. The clinical implications are considered in this paper in relation to the move towards community-based psychiatric services.