High Myopia Mistaken for a Mental Illness – A case report

Chipili Chansa1 and Kangwa I. M. Muma1,2

1Department of ophthalmology, School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia.

2The Eye Hospital—University Teaching Hospitals, Lusaka, Zambia

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A 25-year-old female patient presented to the Chainama College Eye Clinic where she was referred to by a psychiatrist for full eye examination. The patient had been taken to psychiatric filter clinic by her parents to seek help and counselling after observing unusual behaviour. The patient was reported to be isolating herself from everyone and had withdrawn from school. Examination revealed high Myopia which was corrected with spectacles at the facility. Patient’s behaviour changed dramatically, and psychiatric review showed that she was actually not a psychiatric patient.


High Myopia is defined as a condition in which the spherical equivalent objective refractive error is minus 5.00 Dioptres or higher in either eye [1]. It is a relatively severe level of near sightedness that can be associated with significant eye health complications [1]. The onset of high myopia usually starts to develop after age of 10 years, but in other regions it can start earlier or late in life [2]. The main form of treatment in early stage high myopia is prescription for glasses or contact lenses [3]. Global prevalence rates of high myopia were estimated to affect 2.8 percent of the world population in 2010 [4]. Preliminary projections indicate that high myopia will affect 10% of the world’s population [3,4].

The exact prevalence rates of high myopia in Zambia are unknown but from Chainama Eye clinic outpatient records, these cases seem to be on the increase that is from January 2017 to December 2017. Chainama eye clinic recorded 15 cases of high myopia; whereas from January 2018 to December 2018, the cases increased to 22. 

High myopia can be visually and psychologically disabling and tends to affect the level of trait anxiety among young patients [5].

Reeves et al. 2000, reviewed the records of 64 patients with various conditions erroneously admitted to psychiatric units due to lack of thorough history and physical examination [6]. Anxiety traits among young adults and other psychological effects as a result of high myopia may lead to a person being mistaken to have a mental illness and yet not [7].

In the study by Dias et al., 2002, 469 myopic patients reported moderate to high levels of self-esteem. At follow up physical appearance, social acceptance, behavioural conduct and general self-esteem worth levels were noted to have been significantly affected [8]. Lagomasino et al., (1999) and Dias et al. (2002) reported that children who experience more visual problems tend to evaluate themselves less favourably in terms of their physical appearance, school work, social activities, and behavioural conduct as they were affected with low self-esteem [9]. The identification of relationships between a high levels of trait anxiety among myopic young adults can help to define preventive actions aimed at protecting young patients from severe mental disorders [9].


A 25-year-old female presented with poor and blurred distance vision in both eyes which she said to have experienced for 9 years. She had briefly shared her vision difficulties with her parents in the early stages, but the complaint was not taken seriously as there was no one else in the family with similar problems. The parents noted unusual behaviour of the patient with decreasing vision. She withdrew from school, developed depressed mood, and always wanted to isolate herself. She was first taken to the mental filter clinic for attention where a detailed mental health assessment and examination was done, a provisional diagnosis of depressive disorder was made. Patient was further referred to the eye clinic for ophthalmic evaluation.

On examination at the eye clinic, her visual acuity was finger counting at 4 metres Right Eye (RE) and at 3 metres Left Eye (LE). On fundus examination, she had a myopic/tessellated fundus, with no new blood vessels on the retina, and the macular was normal. Intraocular pressure was normal in both eyes at 17.5 mmHg. A diagnosis of high myopia was made and her vision was corrected with spectacles of -10.50/-2.75 X 145 RE, and -14.0 DS LE. Her vision improved to 6/12 in both eyes. The correction of her sight instantly changed her behaviour and looked happy. Her quality of life remarkably improved as she went back to school and freely socialised with her peers and family members. After six months reviews at both the mental filter clinic and eye clinic revealed that she had no psychiatric symptoms nor was she a mental patient; and that she had adapted well to her spectacle prescription.

The patient consented to having her case published, but her names and location withheld.  


High myopia is a severe form of near sightedness that can be associated with significant eye health complications and psychological effects [1]. In this case report the patient under review presented with severe visual impairment and strange behaviour.

According to Cohen et al., 2005, anxiety traits among young adults and other psychological effects as a result of high myopia are not uncommon [7]. High myopia is usually, personally and psychologically disabling and tends to affect the level of trait anxiety among young patients [7,8].

Such traits and other psychological effects if misunderstood may lead to a person being mistaken to have mental illness when in fact not; just as in the case under review. Caregivers or General Clinicians may assume that a patient exhibiting strange behaviour will always need psychiatric diagnosis, treatment, or admissions when not. In this case of a 25 years old high myopic female patient, she was mistaken to be a mental patient simply based on the behaviour that those around her observed; when in fact the changes in her behaviour was largely as a result of the psychological impact of her visual challenges.

Poor vision impacts upon nearly every daily activity that people are used to undertaking. It is easy for those with poor vision to begin to feel isolated as their daily interaction with other people decreases [7]. In this case the patient exhibited isolation from others.

Preconceived assumptions regarding psychiatric presentations and pitfalls of omission in the evaluation of patients with psychiatric symptoms allow medical mimics to go undetected [8]. 


High myopia resulting in blinding can lead to psychiatric condition. Early diagnosis and treatment of high myopia in patients presenting in psychiatric centres is an effective intervention. Multidisciplinary actions of the clinician’s skill both at the mental and eye units played a very important role in arriving at the correct diagnosis and treatment. Hence the need to scale up community eye health awareness programmes in an integrated approach at all levels of health care.

Disclosure Statement

The authors have no conflicts of interest.


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