Trauma-related eye removal is associated with increased psychiatric morbidity compared to other surgical indications: a retrospective cohort study

Background/aims To evaluate psychiatric outcomes following enucleation or evisceration (EE) and determine whether these outcomes differ by the underlying aetiology related to surgery, including trauma, blind painful eye, infection and malignancy. Methods This retrospective cohort study utilised the TriNetX Research Network, analysing deidentified records of 20109 patients who underwent EE. Psychiatric outcomes were compared with 325108 patients who underwent other major ocular surgeries. Patients were propensity-score matched, and EE cases were stratified into trauma, blind painful eye, infection or malignancy cohorts. Outcomes included new diagnoses of depression, anxiety, stress and adjustment disorders, substance use disorders and new prescriptions of antidepressants or anxiolytics within 1 year. Predictors of psychiatric outcomes were evaluated using the Cox proportional hazards models at 3 years postindex. Results Compared to matched controls, the EE cohort had higher rates of antidepressant use (risk ratio, RR 1.14; 95% CI, 1.04 to 1.25; p<0.01) and anxiolytic use (RR 1.15; CI, 1.07 to 1.25; p<0.01), despite similar diagnostic rates of depression. Among subgroups, trauma-related EE was uniquely associated with elevated risk of depression (RR 1.85; CI, 1.06 to 3.21; p=0.03), antidepressant use (RR 2.18; CI, 1.45 to 3.26; p<0.01), anxiolytic use (RR 1.63; CI, 1.13 to 2.33; p<0.01) and substance use disorders (RR 2.04; CI, 1.10 to 3.79; p=0.02). Trauma remained an independent predictor of depression after adjusting for psychiatric history and covariates (HR 1.34; CI, 1.11 to 1.62; p<0.01). Conclusion Psychiatric morbidity following eye removal is influenced by related surgical aetiology. Traumarelated EE carries a distinctly higher psychiatric burden, supporting the need for targeted mental health screening and intervention in this vulnerable subgroup.