eye

2. Eyes as Window to the Mind
Prof. Hani Hamed Dessoki, M.D.Psychiatry
Acting Dean, Faculty of Nursing
Prof. Psychiatry
Founder of Psychiatry Depart., Beni Suef University
Supervisor of Psychiatry Depart., El-Fayoum University
Treasurer of Egyptian Psychiatric Association
APA member
2019

3. Eyes as Window to the Mind

4. ‫عيون‬ ‫حكيم‬
•‫العين‬ ‫فى‬ ‫افهم‬ ‫عيون‬ ‫حكيم‬
‫العين‬ ‫رموش‬ ‫فى‬ ‫كمان‬ ‫افهم‬ ‫و‬
•‫فين‬ ‫ساكن‬ ‫هواهم‬ ‫اعرف‬
‫منين‬ ‫ييجي‬ ‫دواهم‬ ‫اعرف‬ ‫و‬
•‫عنهم‬ ‫كتير‬ ‫وقريت‬ ‫منهم‬ ‫كتير‬ ‫قاسيت‬

5. Nature
10 APRIL 2019
Eyes hint at hidden
mental-health
conditions
Eye examinations
could enable
clinicians to detect
early signs of
neurological and
neuropsychiatric
conditions.

6. The Eyes Are the Windows to the Mind:
Direct Eye Gaze Triggers the Ascription
of Others’ Minds

7. The Eye
• Eye gaze is a potent source of social
information with direct eye gaze signaling
the desire to approach and averted eye
gaze signaling avoidance.

8. • Our eyes don’t lie: they’re windows
to the soul.
• They show the truth, no matter what
face we put on, in any situation.
• The best way to get to know
someone is to look them in the
eyes and observe what they
reveal about their emotional state.

9. • Our eyes, just like our body language,
give us away, and they say more than we
ever could with words.
• As a matter of fact, most of the information
we convey is through nonverbal
language, which ranges from simple
looks to all of the movements we make.

11. The nonverbal language of our eyes
• Here’s an interesting list of some of the information
that eyes can convey:
• Happiness
When your eyes elongate, wrinkle, and shine more than
normal, you probably feel pretty good. You don’t need to
see someone smile to notice that they’re happy.
• Attention
If someone is looking at you with open eyes and a
penetrating gaze, it means they’re paying attention to
what you’re saying and to what’s happening. If they’re
talking to you, they’re paying attention to your words, and
you’d have to focus on other nonverbal features to figure
out if they’re judging you for better or worse.

12. The nonverbal language of our eyes
• Sadness
Through the windows of the soul, we can see sadness, one
of the emotions we feel the most but often try to hide. In
this case, the eyelids raise, as does the lower edge of the
eyebrows.
• Anger
When we get angry, our eyebrows arch, and our
expression is completely serious. Sometimes, we even
frown.

13. The nonverbal language of our eyes
• Uncertainty or evaluation
When we listen to someone and narrow our eyes, we’re
indicating that we’re either evaluating what they’re saying
and doubting its validity, or we don’t understand what
they’re saying. Half-closed eyes can also indicate
tiredness.
• Sexual desire or concentration
• When we feel sexual desire or concentrate, the
pupils dilate like we’ve mentioned before, which leaves
us completely exposed to the other person. We can’t
avoid it, so we usually rub our eyes because they get
wet and we feel uncomfortable.

14. To improve diagnosis and tracking of
schizophrenia
• To improve diagnosis and tracking of
schizophrenia, researchers have been
hunting for biomarkers — measurable
physiological signals that can indicate a
condition’s onset and progression.
• And in the past decade, research has
begun to point to a promising source of
such signals: the eye.

15. The Retina
• For instance, the thickness of a person’s retina
— the layer of light-sensitive tissue at the back
of the eye — or the retina’s response to light
could provide early signs that an individual is
affected by or at risk of schizophrenia.
• “The retina is essentially a proxy for what’s
happening in the brain,” says Steven Silverstein,
a clinical psychiatrist at Rutgers University in
Piscataway, New Jersey.

16. The eye
• The potential to use the eye as a window on the
brain goes beyond just schizophrenia.
• As understanding of the links between eye and
brain health deepens, evidence is building that
changes in the condition or function of the eye
can hint at the presence and progression of
neurological disorders, as well as brain injuries
such as concussion.

17. • With that in mind, researchers are now
taking advantage of improved imaging
technology to develop simple, minimally
invasive tools for examining the eye and
vision to help screen for, diagnose and
monitor neurological and mental-health
conditions.

18. Vision changes
• Vision is thought to require the use of
about half of the brain’s neural pathways,
says Laura Balcer, a neuro-
ophthalmologist at New York University
Langone Health in New York City.

19. Vision changes
• Indeed, researchers have known for decades
that certain neurological disorders can bring
about changes in vision and eye motion.

20. • Much of the work to assess neurological
conditions through the eye has been done
in the context of multiple sclerosis.
• In this disorder, the immune system
disrupts communication in the central
nervous system by attacking myelin, a
fatty substance that forms a protective
layer around nerve fibres.

21. • The process damages several parts of the
brain, including those involved in pathways
that are responsible for vision, and the
optic nerve, which carries impulses
between the eye and the brain.

22. • Although people with multiple sclerosis
often report having vision problems,
standard eye tests — in which a person
reads letters printed in black from a chart
with a white background — typically fail to
uncover any issues

23. • So, in the early 2000s, Balcer and her
collaborator Steven Galetta, also a neuro-
ophthalmologist at Langone Health,
helped to develop an alternative test that
uses the Sloan low-contrast letter-acuity
chart, in which a person has to identify
grey letters on a white background — a
task that is more difficult for people with
multiple sclerosis, because they require
greater levels of contrast than do people
without the condition.

24. • The test has since become the leading
tool for monitoring and studying vision
problems associated with the condition.

25. • Researchers are also developing tests that
make use of other visual pathways to
diagnose multiple sclerosis.
• The King-Devick test, developed by King-
Devick technologies in Oakbrook Terrace,
Illinois, assesses the brain pathways that
control eye movement by requiring a
person to read rapidly from a page of
single-digit numbers.

26. • And a test known as the Mobile Universal
Lexicon Evaluation System (MULES) asks
participants to name images of objects
as fast as they can to test pathways for
colour perception, memory and object
recognition.

27. • These new tests can also help to diagnose
concussion that is incurred while playing
sport.
• Currently, a medical professional or
athletic trainer has to assess a person for
a range of symptoms, including dizziness,
nausea and general confusion — a task
that is often subjective.

28. Mapping the eye
• Neurological injuries and disorders can
also cause physical damage to the retina
and optic nerve that could give
researchers an insight into the underlying
condition.

29. Mapping the eye
• That’s because the brain and the eye are
linked physically by the optic nerve.
• In fact, certain parts of the eye, including
the retina, are essentially an extension
of the brain, having developed from the
same embryonic tissue.

30. • Examining the retina has become much
easier since the advent of a non-invasive
imaging technique called optical
coherence tomography (OCT), about 30
years ago.

31. Optical Coherence
Tomography (OCT),

32. OCT
• In OCT, the eye is scanned with a beam of
light. The light that is reflected back is
analysed to produce a 3D image of the
retina.
• Used mainly to monitor and diagnose eye
conditions such as glaucoma or age-
related macular degeneration, OCT has
now become a tool for studying,
monitoring and potentially diagnosing
neurological disorders.

33. • The technique has revealed, in detail, how
multiple sclerosis thins the retina and
damages the optic nerve, leading to
inflammation — a condition called optic
neuritis.
• And by combining OCT with tests for low-
contrast vision, researchers have
uncovered a correlation between a
thinning retina and vision problems in
multiple sclerosis.

34. • Galetta and Balcer say that OCT-based
observations of the optic nerve should be
incorporated into standard criteria for
diagnosing the condition.
• At present, such a diagnosis requires the
identification of lesions in the central
nervous system by magnetic resonance
imaging (MRI).

35. • Although optic-nerve lesions are often
present before symptoms appear, they are
rarely used in diagnosis.
• The optic nerve is difficult to image by MRI
because it is small and the eye moves
constantly.
• OCT, however, boasts a resolution that is
1,000 times greater than that of MRI, and
the technique is therefore more sensitive
to optic-nerve lesions.

36. From Imaging the Brain to Imaging the Retina:
Optical Coherence Tomography (OCT) in
Schizophrenia
Carlos Schönfeldt-Lecuona, Thomas Kregel, Arno Schmidt, Elmar H.
Pinkhardt, Florian Lauda, Jan Kassubek, Bernhard J.
Connemann, Roland W. Freudenmann, Maximilian Gahr
Schizophrenia Bulletin, Volume 42, Issue 1, January 2016, Pages 9–
14, https://doi.org/10.1093/schbul/sbv073
Published:
05 June 2015

37. • Abstract
• Findings from computer-based magnetic resonance
imaging analyses and neuropathological studies support
the hypothesis of a degenerative component of certain
psychiatric disorders such as schizophrenia.
• Studies in schizophrenia incorporating OCT are currently
rare and have yielded further heterogeneous results.
• This article elucidates the method of OCT and the
retina’s role as a “window to the brain”.
• Furthermore, in delineating the degenerative
components of schizophrenia, we discuss the possible
applications of OCT in the schizophrenia population.

39. Schizophrenia—Another Disorder for
Exploring Neurodegeneration With OCT?
• Rsults from opthalmological studies of
patients with schizophrenia have indicated
that patients with schizophrenia exhibit a
variety of visual deficits, suggesting
impairment in the earliest components of
the visual tracts.

40. • Deficits in visual-evoked potentials or
behavioural tests demonstrate a rather
selective impairment of the magnocellular
pathway that is responsible for object
motion and assessing spatial
relationships.

41. Optical coherence tomography: a window into the
brain of schizophrenic patients
L CABEZON
F ASCASO
P RAMIRO
MA QUINTANILLA
L GUTIERREZ
A LOBO
JA CRISTOBAL
First published: 06 August 2012
https://doi.org/10.1111/j.1755-3768.2012.T123.x

42. • Abstract
• Purpose Our study aims to assess peripapillary retinal nerve fiber layer (RNFL) thickness,
macular thickness and volume, and optic nerve head (ONH) measurements in patients affected by
schizophrenia
• Methods 30 schizophrenic patients (mean age 44.5 +/‐ 10.9 years) were enrolled. They were
compared with 30 age‐matched controls. In all subjects, peripapillary RNFL thickness, ONH
measurements, macular thickness and volume were measured by optical coherence tomography
(OCT). The eye studied was the right eye
• Results Schizophrenic patients showed an statistically significant reduction of the overall
peripapillary RNFL thickness (95.1+/‐ 13.4 µm) compared with those values observed in control
eyes (103.3+/‐9.0 µm) (p=0.008, Student t test). We also observed reduced peripapillary RNFL
thickness in superior quadrant in schizophrenic patients (114.7+/‐18.0 µm) when compared with
controls (127.3+/‐ 14.4 µm) (p=0.004, Student t test). Cup/disk area ratio (cases: 0.45 +/‐ 0.31;
controls: 0.26 +/‐ 0.27 p=0.002, Mann‐Whitney U test), cup/disk horizontal ratio (cases: 0.67 +/‐
0.22; controls: 0.48 +/‐ 0.23 p=0.003, Student t test), cup/disk vertical ratio (cases: 0.60 +/‐ 0.24;
controls: 0.44 +/‐ 0.23 p=0.003, Mann‐Whitney U test) and cup area (cases: 1.32 +/‐ 1.09;
controls: 0.73 +/‐ 0.82 p=0.001, Mann‐Whitney U test) were statistically increased in
schizophrenic patients.
• Conclusion Schizophrenia patients showed a reduction in peripapillary RNFL
thickness evaluated by OCT and an increase in some measurements of ONH.
These findings suggest that as previously observed in neurodegenerative
disorders.

43. • OCT also holds promise for identifying
early signs of the neurological conditions
Parkinson’s disease and Alzheimer’s
disease, which could enable people to be
treated before symptoms develop.

44. • A team of researchers at Seoul National
University used OCT to show that thinning
of the retina was correlated with both an
increasing severity of Parkinson’s disease
and the death of neurons that produce the
neurotransmitter dopamine, the loss of
which causes Parkinson’s disease.

45. • Researchers in the United States
combined OCT with angiography, a
technique for imaging blood vessels, as
part of efforts to find early biomarkers of
Alzheimer’s disease.

46. • The team compared healthy retinas with
those of people who had elevated levels of
amyloid-β — a peptide linked to
Alzheimer’s disease — but who did not yet
exhibit symptoms of the condition.

47. • They found that the foveal avascular zone,
a region of the retina that lacks blood
vessels, was about one-third larger, on
average, in people with elevated amyloid-
β.

48. • The data are limited but promising, says
Gregory Van Stavern, a neuro-
ophthalmologist at Washington University
in St. Louis, Missouri, who co-led the
study. “We’re very enthusiastic to see if we
can replicate it, and see if we can show
this could be a really useful tool for
screening down the line,” he says.

49. From eye to mind
• Researchers are also looking to the eye
for early biomarkers of neuropsychiatric
disease, which could enable clinicians to
intervene before their onset or thwart their
progression.
• For instance, there is evidence that, in
people with schizophrenia, the small
veins, or venules, of the retina are wider
and the retina is thinner

50. Electroretinography, which
measures the retina’s response
to light, is being tested as a
possible tool for identifying
people at risk of developing
schizophrenia.
Credit: LKC Technologies

51. Electroretinography
• Perhaps the most promising tool in the
short term for identifying people at risk of
developing schizophrenia is
electroretinography, a simple and
minimally invasive test that measures the
retina’s electrical response to light.

52. Electroretinography
• That signal is captured using a small
electrode that is attached to the cheek
below the eye or placed under the upper
or lower eyelid.
• “It feels like you have a hair in your eye for
about a minute and then you don’t really
notice it anymore,” Silverstein says.

53. Electroretinography

54. • A team of researchers led by clinical
psychiatrist Michel Maziade at Laval
University in Quebec City, Canada, has
used electroretinography to identify how
the response of light-sensitive cells in the
retina called rods and cones changes in
people at risk of or diagnosed with
neuropsychiatric conditions such as
schizophrenia and major depressive
disorder.

55. • In 2010, the researchers found that the
rods of young people with a high genetic
risk of developing schizophrenia respond
more weakly to light than do those of
young people without that risk.

56. • Individuals considered to be at risk had
one parent who had been diagnosed with
bipolar disorder or schizophrenia, but
showed no symptoms themselves, which
suggests that electroretinography can help
to identify people who might benefit from
medical intervention before symptoms
appear.

57. • Electroretinography have documented
altered electrical activity in the cone
photoreceptors represented by the a-wave
amplitude, and additionally being inversely
related to the positive symptoms.

58. • Deviations in dopamine and serotonin
transmission affect the electroretinogram
(ERG) measures.
• Therefore, ERG abnormalities may be
associated with central monoaminergic
dysfunction.

59. • With regard to dopamine as a retinal
neurotransmitter especially released by
amacrine cells.

60. Digital Fundus Photography
• Additionally, preliminary results from digital
retinal imaging (digital fundus
photography) in patients with
schizophrenia have demonstrated that
patients show wider retinal venules
compared with matched healthy controls.
• The researchers suggested that this could
be due to an insufficient oxygen supply to
the brain.

61. • Recent findings in the areas of
neuroimaging and neuropathology suggest
parallels between schizophrenia and the
“classical” neurodegenerative disorders.

62. • Certain biochemical findings additionally
underline the degenerative component in
schizophrenia.
• Pathological dysregulation of apoptosis in
the neurons of patients with schizophrenia
is accounted for by the abnormally low
concentration of the anti-apoptotic Bcl-2
and an elevated Bax/Bcl-2-ratio in the
cortex.

63. • A 2015 study with a larger population size
found similar photoreceptor responses to
light in 100 adults with schizophrenia.

64. Eye in Psychiatry
1- Neurocogitive disorders eye exam may
denote the cause by fundus exam may..
retinal edema, increase ICP, Deposits ,
cupper in Wilsons disease
2- Eye examination is important to diagnosis
of organic causes for psychiatric disorders
as in endocrine disorders, ,MS, metabolic
disorders vitamins and electrolyte and
minerals diffeciencies

65. 3 - substance use disorders : nystagmus in
alcohol, conjunctival congestion.
In Hashish and bango intoxication, ppp in
opiate intoxication or dilated pupil in other
substance intoxication
4 - eye contact is AN important sign and it`s
impaired in psychiatric disorders as
schizophrenia, ASD
Eye in Psychiatry

66. 5-The eye is part of emotion examination as
affect , as eye may express wide range of
emotions
6- Disturbance or disorders of perception
can be expressed in vision as illusions,
hallucinations, depersonalization and
derealization
Eye in Psychiatry