A bad breakup, a blowup with your kid, a brutal week at work: any one of these can trigger blurred or darkened vision within hours, through a condition most people have never heard of, according to doctors.
The condition, central serous retinopathy, is heavily intertwined with stress. Many people don’t suspect a connection between a crisis and their eyes. Yet, there’s a clear link between stress and several eye diseases—and it starts with a hormone most of us only associate with feeling overwhelmed.
Intense emotions can cause internal damage, including to our eyes, according to Dr. Mike Cymbor, a glaucoma and eye disease specialist. “Anger, hate, non-forgiveness—it causes so much cortisol to be released,” he told The Epoch Times. “We’re just starting to realize how it all fits together.”
The Cortisol Connection
Eye damage starts with a normal feedback loop between our eyes and our nervous system that ends with the release of the stress hormone cortisol, which drives heightened focus and energy and is critical when we face threats.
Cortisol is made in response to what we see or experience after the amygdala—a key part of the limbic system, which manages emotions—decides we’re in trouble. If we sense a threat, the brain’s hypothalamus—our main control center for maintaining internal stability—communicates with the adrenal and pituitary glands to release cortisol and other hormones.
During an intense one-off event, cortisol can contribute to inflammation and increased eye pressure, both of which influence the progression and severity of eye diseases.
Central Serous Retinopathy
Cortisol tames inflammation in the short term, but causes inflammation when stress is chronic and also contributes to fluid leakage. Fluid behind the retina can build up like a blister, pulling the retina away from the back of the eye, causing central serous retinopathy. It can be symptomless or can cause vision distortions, floaters, and dark spots—even making straight lines appear crooked.
When the hypothalamic-pituitary-adrenal axis is repeatedly or irregularly activated through chronic stress or depression, it can disrupt normal cortisol production, typically resulting in the release of too much cortisol.
Most cases of central serous retinopathy resolve when stress eases, though if symptoms persist for months, medication and laser therapy may be used to treat fluid buildup behind the eyes. The problem, however, can return and, in some cases, has led to permanent eye damage.
Dry Eye Disease
Cortisol-driven inflammation can also disrupt tear production, leading to dry eye disease. Selective serotonin reuptake inhibitors (SSRIs)—medication used for depression and anxiety—can compound the problem because changes in neurotransmitter production reduce tear production.
“When I have a patient who has really bad dry eye or who doesn’t respond as well as I would think to treatment, then I start asking them about anxiety levels, looking at medications that they’re on, and talking to them about gut health,” Cymbor said. “There’s this correlation between anxiety, irritable bowel syndrome, and dry eye that is coming out.”
Beyond inflammation, dry eye and irritable bowel syndrome share neuroimmune dysfunctions. Researchers have also observed different immune cell changes in both conditions.
Just as anxiety disrupts nerve signals in the gut that affect digestion, it also affects nerve signals that control tear production and the eye’s oil glands.
Dry eye disease, which causes stinging, burning, and scratchy sensations, may affect as many as 49 million Americans.
Glaucoma
When cortisol rises, it creates brief eye pressure changes. Typically benign, pressure that stays elevated can damage the optic nerve and cause glaucoma, the leading cause of blindness for those over 60.
“Elevated eye pressure is the primary risk factor for disease progression,” Dr. Usiwoma Abugo, an ophthalmologist and director of oculofacial plastic and reconstructive surgery and aesthetics at Katzen Eye Group in Maryland and spokeswoman for the American Academy of Ophthalmology, told The Epoch Times in an email.
What to Look For When Trouble Is Brewing
Subtler warning signs often precede eye damage and can signal that stress is affecting your eyes. They include tunnel vision, light sensitivity, eye strain, floaters, and eye twitching, Abugo said.
“Extreme anxiety can block your peripheral vision in the moment and make you feel like you can only see objects directly in front of you,” she said.
Tunnel vision can be a healthy stress response, narrowing vision to what our body perceives as most important, and it commonly occurs during panic attacks. However, it can be a sign of more serious issues like stroke, glaucoma, retinal detachment, inflammation of the optic nerve, and diabetes-related retinopathy that often appear with additional symptoms like flashes, shadows in vision, and pain. If tunnel vision lasts more than 30 minutes, you should contact your eye doctor.
Twitching eyelids can also indicate that you’re under a great deal of stress, Abugo said. Lack of sleep and caffeine can worsen eye twitching, creating a vicious cycle of stress.
“As an oculoplastic surgeon, one of the big things that I discuss with patients is the effect of stress on eyelid twitching,” Abugo said. “After ruling out other organic causes of twitching, we always address stress.”
Persistent eye symptoms should be examined by an eye doctor, Abugo said. “Typically, once the stress-related incident resolves, changes in vision or ocular function should stop.”
