Bipolar Eyes: Do Mood Episodes Change Eyes?

Medically reviewed by Dakari Quimby, PhD

Bipolar eyes are eye changes that occur with bipolar disorder. Changes in characteristics such as pupil size, gaze, and brightness may indicate bipolar eyes during distinct disease states.

Certain changes in mood and conduct are the basis for defining bipolar disorder. There is also some proof that certain eye shifts may occur with the onset of manic or depressive stages.

This article describes the changes that define bipolar eyes and how eyes may appear during manic and depressive states. It also explains how to recognize these states and help those dealing with them.

Understanding Bipolar Eyes During Manic Episodes

Manic episodes are periods of at least one week that are commonly characterized by extreme feelings of elation and increased energy. In some cases, these extreme feelings may involve agitation and irritability.

Vision Effects

Bipolar eyes during a manic episode can reflect the state of euphoria and happiness that your body experiences during these periods. Manic eyes can include the following:

• Dilated pupils: Dilated pupils are a state in which the dark center of your eyes widens in reaction to internal or external factors. Pupil size is controlled by your autonomic nervous system, which regulates your body's involuntary processes. Raised levels of norepinephrine, also known as noradrenaline, that occur during manic episodes may be linked to the onset of manic pupils.

• Eye color change: Researchers say that color changes reported in people during manic episodes may be due to the increased contact that occurs between the dark dilated pupils and the sclera (the white area of your eye that covers about 80% of its surface).

• "Sparkling eyes": During a manic episode, eyes described as being bright with a shimmering quality or seeming to shine without wavering is referred to as "sparkling eyes" and is one of the most common observations. This may be linked to the emotions of excitement and euphoria that occur in a manic state.

• Bias in direct gaze: Direct gaze is interpreted as a sign of attention and intention in joint communication. People with bipolar disorder may exhibit a bias of self-referential gaze perception (the over-perception that another person's gaze is toward oneself) and more direct eye gaze, especially in manic states.
  

Understanding Bipolar Eyes During Depressive Episodes

Depressive episodes are periods of at least two weeks in which a person has extreme feelings of despair and sadness. In these cases, people often lose interest in relationships and activities they typically enjoy.

Eye Characteristics

Bipolar eyes are more commonly reported in a depressive state than a manic state. Bipolar eyes during depressive episodes are associated with the following effects:

• Pupil constriction: Pupil dilation is linked with winning or losing something. Researchers reported finding a correlation between pupil dilation in response to an expected reward and the severity of depression. However, the more severe a person's symptoms of depression were, the less their pupils opened (constricted).

• Eye color change: Depressive episodes are linked with decreased facial reactivity around the eyes, typically generating less luminosity. Facial reactions such as eye lag or hooded eyelids may darken the appearance of eyes in people during these episodes.

• Lack of "light in the eyes": Research indicates that depression is linked with more severe dry eye symptoms. The lack of "light in the eyes" seems to reflect constricted pupils as well as loss of "sparkle" linked with ocular dryness.

• Direct gaze: Based on reports of observations, researchers note that people with bipolar disorder demonstrate less direct gaze during depressive states. The reduced gaze may correlate to the compromised performance that occurs in depressive states.
  

Eye Changes in Catatonia/Psychosis

Catatonia is a psychomotor syndrome that can occur in any phase of bipolar disorder. It can have a wide range of symptoms, most often characterized by slow or diminished movement. Eye changes in this condition can include the following:

• Prolonged staring

• Poor eye-to-eye contact

• Decreased blinking
  

Psychosis is a collection of symptoms that affect your mind, resulting in some loss of contact with reality. Research shows that people with schizophrenia (a type of psychosis that includes hallucinations) can have the following eye changes:

• Impaired, lagging, smooth eye movements (movements that occur when viewing an object that keeps the image stabilized in the center of your eye)

• Limited exploratory eye movements that restrict a person's gaze to a smaller visual field than those without schizophrenia
  

What Bipolar Eyes Aren't

Bipolar eyes aren't a reliable method for diagnosing bipolar disorder or the onset of a manic or depressive episode. The eye changes attributed to bipolar eyes can occur for other reasons, such as emotional changes without bipolar disorder.

Eye changes are not routinely used in the medical diagnosis of bipolar disorder. Instead, the diagnosis and treatment of bipolar disorder depends on an evaluation by a mental health specialist such as a psychiatrist or psychologist. It involves a physical exam and questions about your symptoms and their severity.

Learn More: What Are the Differences Between Bipolar 1 and 2?

Signs of Bipolar Eyes to Look For

Bipolar disorder affects everyone differently. Noticing changes in someone's eyes may be a sign that they are undergoing mood or emotional shifts, though these changes are not always caused by bipolar disorder. Other external signs of bipolar disorder, like extreme changes in mood and behavior, may better indicate a change in someone's mental state.

Signs to Recognize

If you think you notice bipolar eyes in someone, look for the following signs that can help you recognize if they are having an episode and may need support:

Signs of a manic episode:

• Feeling wired, jumpy, or more active than usual

• Feeling of euphoria or elation
  

• Being restless, working on several projects simultaneously, or initiating increased activity
  

• Being easily distracted

• Having a very short temper or seeming extremely irritable

• Having uncontrollable, racing thoughts

• Talking quickly and loudly

• Feeling energetic despite sleeplessness or insomnia

• Feeling like you are especially talented, important, or powerful

• Participating in risky and impulsive behavior like overeating, drinking too much, reckless driving, overspending, or reckless sex

Signs of a depressive episode:

• Feeling sad, down, worried, or worthless

• Feeling anxious, empty, guilty, or hopeless

• Feeling fatigued with low or no energy

• Lacking interest in friends, family, and usual activities

• Being forgetful and/or indecisive

• Difficulty concentrating

• Getting too much or too little sleep

• Eating too much or too little food

• Thoughts of suicide and/or death
  

Ways to Offer Support

Obvious changes in mood and normal behavior are the best way to determine if someone is having a bipolar episode. If you notice someone displaying signs of bipolar disorder, consider these tips from the International Bipolar Foundation to offer support:

• Avoid using combative or patronizing words like "calm down" or "relax" since they may not be in control of their behavior or mood.

• Don't take their actions personally. Their mood and behavior have nothing to do with you.

• Give them space if they prefer to be alone. However, intervention may be necessary if they are talking about self-harm or harming others.

• Keep them company. Interact with them to keep them busy and safe without making them feel embarrassed about their behavior.

• Protect them from harm. Be aware of the harm they may inflict on their health or lifestyle by actions like overspending, excessive drinking, or other careless behavior.

• Discuss the advantages of taking away their phones during episodes. Having their phone in hand can be a temptation for overspending or other types of reckless actions.

• Encourage behaviors that aren't harmful. Allow them to work through obsessions that are not harmful so they can move past them.

• Contact their psychiatrist or mental health provider or encourage them to do so if their advice is needed.

• Remind them to take care of their health, including taking daily medication. Help them meet these requirements without making them feel guilty.

• Prepare for a depressive episode. Talk with them about ways to handle their needs during these times.

• Provide physical, emotional, and overall general support. Whether they need a hug, unconditional love, or physical assistance, be ready to offer whatever help they need to succeed.

Dealing With a Heightened Bipolar Episode

Dealing with the heightened emotions that occur with bipolar disorder can be daunting. The most severe episodes can trigger psychotic symptoms such as hallucinations (seeing or hearing things that do not exist) or delusions (false beliefs).

If you have a diagnosis of bipolar disorder, the following steps can help you manage your emotions:

• Keep a consistent sleep schedule.

• Maintain a healthy lifestyle by eating well, reducing stress, and getting regular exercise.

• Take daily medication as prescribed.

• Keep a mood journal to track how your feelings change from day to day in case medication changes are needed.

• Avoid alcohol and other drugs

• Maintain a support network of family and friends willing to help during a crisis.
  

If you or a loved one is having thoughts of suicide, call 911 immediately, or call or text 988 for the 988 Suicide & Crisis Lifeline.

Summary

Bipolar eyes describe changes such as pupil size, eye brightness, and gaze that occur with bipolar disorder. These changes differ in the manic vs. depressive stages of this disease.

There are some reports that bipolar eyes exist. However, it is not enough to use these changes as diagnostic tools.

Both disease states are defined by common mood and conduct changes. These are the criteria used when defining this mental health condition.

If you or someone you love have symptoms of bipolar disorder, do not attempt to self-diagnose your problem. Getting the right diagnosis and treatment is key to helping you or your loved one function safely in daily life.

Read the original article on Verywell Health.