Have you ever felt like your eyes were playing tricks on you? For people living with schizophrenia, that feeling might be all too familiar. Schizophrenia doesn’t damage the eyes, but it can change visual perception — how the brain processes what the eyes see. When perception changes, vision can feel distorted, confusing, or even frightening.

Changes in how the brain processes information can make your surroundings seem “off.” This can lead to psychosis, which may include delusions (false beliefs not based in reality) and hallucinations. Hallucinations are most often auditory (hearing things that aren’t there) but can also be visual (seeing something that isn’t there). You might also have blurred vision or notice that objects look distorted, which can be symptoms of schizophrenia or side effects of medication.

In this article, we’ll explore why vision changes happen, which kinds of vision abnormalities (changes) are most common, and how to protect your eye and brain health.

How Do the Brain and Eyes Work Together?

Your eyes collect light and turn it into electrical signals. These signals travel along the optic nerve to the brain’s visual cortex, located at the back of your head. Here, neurons (brain cells) work together to produce the images you see. This pathway from your eyes to your brain is the basis for visual processing.

Vision problems affect as many as 50 percent to 60 percent of people with schizophrenia.

Schizophrenia and the Eyes

In schizophrenia, changes often occur in brain structure, neurotransmitter activity, and information processing. Neurotransmitters are the chemical messengers neurons use to communicate with each other. Dopamine and glutamate are two important neurotransmitters involved in vision and schizophrenia. When one or both of these messengers are out of balance, it can lead to visual distortions or visual hallucinations.

Testing for Vision Changes With Schizophrenia

Vision changes in schizophrenia can sometimes show up in brain and eye tests. Functional magnetic resonance imaging (fMRI) can reveal how different parts of the brain work together while you’re looking at something. Optical coherence tomography (OCT) uses special lenses to take detailed pictures of the retina (the light-sensitive layer at the back of your eye).

Researchers have found small differences in the retina of some people with schizophrenia. They’ve also observed changes in how the eyes move. Normally, your eyes smoothly follow a moving object, known as smooth pursuit eye movements. Your eyes can also make quick jumps from one spot to another, called saccades. In some people, schizophrenia can affect both types of eye movements.

What Vision Changes Occur in Schizophrenia?

As many as 50 percent to 60 percent of people with schizophrenia report some form of visual dysfunction. These changes can happen at any stage, including during a first episode of psychosis or later in life with late-onset schizophrenia. Types of vision changes can include:

• Faces that look distorted
• Objects that seem smaller or larger than usual
• Colors that look overly bright
• Trouble with contrast sensitivity (distinguishing differences between light and dark)
• Difficulty smoothly following a visual stimulus across a room

If you notice sudden loss of vision in one or both eyes, a sudden burst of light or flashes, or floating spots, seek medical help right away.

These changes differ from positive symptoms of schizophrenia, which may involve visual hallucinations. Instead, these visual changes affect the way real things look. Some people even notice visual changes before other symptoms begin — during what’s known as the prodromal phase of schizophrenia.

It’s important to remember that these problems affect how the brain processes what you see, not the health of your eyes. However, they can be mistaken for common vision problems.

Why Do Vision Changes Happen in Schizophrenia?

Vision changes aren’t unique to schizophrenia — they can also occur in other brain-related conditions, such as bipolar disorder and Parkinson’s disease. Researchers don’t yet fully understand why these symptoms happen in schizophrenia, but they have several theories, which involve:

• Dopamine and glutamate imbalance — Too much or too little of these neurotransmitters can disrupt how the brain’s visual areas work together.
• Abnormal eye movements — Problems with saccades or smooth pursuit eye movements can make moving objects look jumpy or broken up.
• Retinal changes — Some people with schizophrenia have small structural differences in the retina.
• Other neurological (brain-related) or mental disorders — Conditions like a serious head injury, stroke, or mental health disorders can also affect vision.

How Does Medication for Schizophrenia Affect Vision?

Antipsychotic medications are essential for managing schizophrenia symptoms. However, some of these drugs can cause visual side effects, including:

• Blurred vision
• Dry eyes
• Difficulty reading
• Trouble focusing on near or far objects
• Sensitivity to light

In rare cases, more serious eye problems may occur, such as:

• Forced upward gaze (involuntary upward eye positioning)
• Nystagmus (repetitive, uncontrolled eye movements)
• Narrow-angle glaucoma (sudden buildup of pressure that can damage the optic nerve)

Be sure to have your eyes checked regularly by an ophthalmologist or optometrist (eye care specialist).

Not everyone experiences these side effects, and some may improve after your body adjusts. Others may require adjustments to your treatment plan. If you notice any changes in your vision or eyes, tell your healthcare team right away. Some medicines can also affect the retina or how your eyes respond to light, so regular eye exams are important.

How Do Vision Changes Affect Daily Life?

The brain depends on vision more than any other sense, so disrupted vision can have a big impact. For example, if objects appear jumpy or blurred, crossing the street or driving can feel unsafe. Visual distortions can make everyday tasks, like reading or following a conversation, harder, especially if faces or expressions look different.

Some people may avoid social settings if they feel they can’t trust what they’re seeing, which can lead to social isolation. Over time, these challenges can cause increasing frustration and make other symptoms of schizophrenia feel worse.

What Should You Do if You Notice Vision Changes?

If you notice new or worsening vision changes, you can take steps to get help and feel safer. Here’s how to start:

• Track your symptoms — Keep a simple journal of what you see, when it happens, and what you were doing at the time.
• See an eye care specialist — Make an appointment with an ophthalmologist (a medical doctor who specializes in eye care). Let them know you’re living with schizophrenia, and describe your vision symptoms.
• Talk with your (mental health) team — Tell them about all your eye-related symptoms. They can make adjustments to your treatment plan if needed.

Most people should have a yearly eye exam. If you’re taking medication that can affect your eyes, you may need to get them checked more often.

How Are Vision Problems in Schizophrenia Treated?

If your antipsychotic medication is causing blurred vision or dry eyes, talk with your healthcare provider. They may adjust the dose or switch you to a different medication. If that doesn’t help, lubricating eye drops may help relieve dryness.

Be sure to have your eyes checked regularly by an ophthalmologist or optometrist (eye care specialist). Wearing glasses or contacts with an outdated prescription can lead to unnecessary eyestrain, which may contribute to visual symptoms.

When Should You See an Eye Doctor?

If your vision problems are mild and don’t interfere with daily life, you can mention them at your next scheduled appointment. However, if you notice sudden loss of vision in one or both eyes, a sudden burst of light or flashes, or floating spots, seek help right away. These may be signs of serious eye conditions, such as retinal tears or bleeding, that need immediate treatment to prevent permanent damage.

It’s also important to act quickly if you have ongoing eye pain, redness that doesn’t go away, or sudden, severe light sensitivity. Tell your psychiatrist (mental health provider) about these symptoms, too. They can help determine if these symptoms are related to your medication or something else.

Join the Conversation

On MyDepressionTeam, people share their experiences with depression or related mental health conditions, get advice, and find support from others who understand.

Have you experienced eye or vision problems with schizophrenia? What has helped the most for you? Let others know in a comment below.