Patients' Eyes

[hebel]

Does anyone else generally notice what feels like an almost instinctual ability to get a quick sense that something is "off" with a patient largely from their eyes?

Even more than that, there really seems to be different "types" of eyes....as in delirium, dementia, drug intoxication, and psychosis (to name the major ones) each have a certain "look."

I'm asking this here to see if there's been any attempts in the research to explain this, because as I type the above I realize this all sounds very unscientific and subjective.

Again, it can be really powerful at times to the point where within a literal two seconds of entering the room you basically want to say "oh hey, you're back!" because you can immediately tell the patient is back to "normal."

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[Sushirolls]

Eyes are fixed, static, "boring", except for pupil mm size, or sclera redness.

I'd extend your observation to affect in total, which is what gives life to eyes.

 

[Crayola227]

I disagree about the static boring thing. One thing to include is saccadic movements which can tell you a lot. And of course what the lids are doing and the rest of the face.

 

[PsyDr]

You’re including some non- eye stuff in there. There is a ton of infant bonding and schizophrenia research that tracks the millisecond movements of our eyes when assessing people’s faces. Seems like we are looking at a lot even if we think we are just looking at the eyes. That’s just a byproduct of a few million years of evolution, which decided to dedicate substantial biological real estate to vision and facial processing.

If you’re dealing with intoxication and psychosis, you’re likely dealing with DA streams. Therefore, it might be helpful to use Parkinson’s as a model. LGN is all messed up. V1 is kinda messed up, which creates problems with salience mapping in later stages. The dual stream of facial recognition is messed up, and shows differential response to dopamine agonists (I.e., fusiform behavior and amygdala behavior, which are high and low frequency sampling behaviors respectively). Saccades are hypometric. V5 motion speed perception is a bit messed up which is why the patient might respond differently based upon how quickly the visual stimuli is moving. You know... all that visual stream stuff we had to memorize in undergrad, and then forgot.


The direct response to your questions is, yes. In psychology, formal assessment of this behavior is part of Ekman’s Facial Activation Coding System. It’s a super boring training that requires you to go second by second of video, and codify each aspects of facial behavior each time. If you’re not already super bored, the stuff you are referring to are items 1-2, and 61-68. These items reflect the behaviors of the orbicularis oculi, fronatalis, levator, and oblique and recti groups.