Bipolar disorder is a complex mental health condition that can show up in very different ways.
Not only do three main types exist, it’s also possible to have a diagnosis of bipolar disorder not otherwise specified. This diagnosis reflects mood symptoms that, while consistent with bipolar disorder, don’t quite align with the other types.
What’s more, shifts to mania, hypomania, or depression happen infrequently for some people — but far more often for others. Four or more mood episodes in a year typically leads to a diagnosis of rapid cycling bipolar disorder.
In short, there’s a lot more to the condition than the euphoric high of mania followed by the plummeting low of depression. Yet this “classic” presentation of bipolar 1, often seen in movies and TV, is how most people understand the condition.
Mania itself is often stereotyped, too: shopping sprees, heightened sexuality, increased creativity, and productivity. Some people even suggest you can see mania in someone’s eyes.
Bipolar disorder can, in fact, affect the eyes — but not in the way you might think. Read on to learn what scientific evidence has to say about “bipolar eyes.”
You’ll find more than a few anecdotes suggesting bipolar disorder can change the appearance of the eyes, generally by affecting pupil dilation, gaze, and even eye color.
So-called bipolar eyes might include:
- dilated pupils
- “sparkling” eyes, or eyes that appear more liquid than usual
- eyes that change color or become black
- widened or narrowed gaze, depending on the type of mania (Some say dysphoric mania, or a mood episode with mixed features of mania and depression, leads to a narrowed or squinting gaze.)
Since these supposed eye changes happen during episodes of mania, you might also hear them described as “manic eyes.”
For many people, mania does involve increased excitability, energy, and restlessness. Eyes can certainly reflect these mood shifts. Excitement, for example, could easily lead to wider eyes, or eyes that seem to shine and sparkle.
Of course, bipolar disorder involves more than just excitement and high energy. Symptoms of psychosis, including delusions or hallucinations, can also happen during manic episodes. Since delusions and hallucinations can feel frightening, pupils may dilate in response.
The release of this hormone can, again, lead to pupil dilation.
Sure, some people with bipolar disorder (or their loved ones) might notice some changes in their eyes and gaze during a mood episode.
But since this won’t necessarily hold true for everyone, this assumption can be unhelpful, if not downright harmful. For example:
- If you suspect you could have bipolar disorder but don’t notice anything different about your eyes, you might put off seeking professional support and treatment.
- Maybe you look for changes in a loved one’s eyes to recognize when they’re having a mood episode. If you don’t notice any sparkling or color changes, you might assume they’re just fine and fail to notice other key signs.
Mixed features mood episodes involve both mania and depression symptoms, such as:
- low mood accompanied by extreme energy and restlessness
- irritability and anger combined with racing thoughts and fast speech
- inability to stop laughing despite a sense of worthlessness or despair
These emotions may feel more overwhelming and difficult to manage. Anger and irritability could appear very clearly in facial expressions, including the eyes — but not necessarily for everyone. Some people simply have more expressive faces.
Keep in mind, too, that plenty of everyday experiences can prompt feelings of excitement, fear, or anger. People living with bipolar disorder can still experience these common emotions, whether they’re having a mood episode or not.
It’s also worth keeping in mind that both depression and mania can lead to changes in sleeping habits, which might affect the eyes. For example:
- Someone who always feels tired and fatigued might have trouble focusing and keeping their eyes open.
- Someone who isn’t getting the right amount of sleep might have more bloodshot eyes. They might also blink more often, due to the dryness and irritation that can accompany lack of sleep.
To date, no scientific studies have explored changes in eye color or shape as a result of bipolar disorder. In other words, no actual evidence supports these anecdotes.
There is, however, some evidence to suggest bipolar disorder can involve changes in eye movements.
Saccadic eye movements
Saccadic eye movements are quick, sudden movements that change the direction of eye focus, generally toward an object of interest. These movements often happen as a reflex, but you can also make them intentionally.
For example, you make these movements when you:
- read a book
- look around a store to find the department you want
- respond to a sudden loud noise
Several studies evaluated in the review included people with bipolar disorder. Some results suggest people living with the condition tend to have a harder time with anti-saccadic eye movements, or movements away from the target of focus.
Researchers noted, for example, a slower reaction time and more errors when comparing people with bipolar disorder to controls.
Most of the studies were fairly small, though, and more research is needed.
Eye movements and emotion
The review authors found evidence to suggest the following:
- People living with either condition tended to have a slower reaction time for both saccadic and anti-saccadic movement tasks. For those with bipolar disorder, episodes of depression seemed to lead to more of an increase than a manic episode.
- People with bipolar disorder also made more errors in gaze fixation tasks, which involve keeping the eyes fixed on a specific target. The review authors suggested this may relate to the impulsivity commonly associated with the condition.
- People with bipolar disorder tended to fixate on threatening images, whether they were having a mood episode or not. During an episode of depression, they spent more time looking at negative images and less time looking at positive images. In fact, one study even noted they had difficulty holding eye contact on any positive images. The review authors believed this may relate to the difficulty feeling pleasure that often characterizes depression.
Again, many of these studies had smaller sample sizes, and the review authors emphasized the need for more research.
Vergence eye movements
A 2019 study explored differences in vergence eye movements by comparing 30 adults experiencing bipolar disorder with 23 control participants.
Vergence eye movements, in basic terms, align your eyes with an object of interest. Your eyes move in different directions, with your line of sight meeting or separating, so you can focus on something that’s either closer to you or farther away. These are also known as binocular eye movements.
Using an oculometer, researchers analyzed the participants’ reactions to various eye movement tasks.
Their findings suggested people with bipolar disorder tend to make more errors in vergence eye movements and experience more irregular saccadic eye movements, like so-called “catch-up saccades” (which help a slow-moving gaze catch up with the object of interest).
To an observer, this could seem like rapid eye movements, or fast eye movements in different directions.
Study authors also noted that people who’ve had bipolar disorder for a longer period of time may show more irregularities in these eye movements. They suggested the progression of bipolar disorder as one potential explanation for changes in eye movements.
Experts have found another connection between bipolar disorder and the eyes — one that requires specialized medical equipment and expertise to identify.
Study authors used an electroretinography (ERG) test to compare the retinas of 29 young adults who had one parent experiencing either schizophrenia or bipolar disorder with 29 young adults with no family history of the conditions.
An ERG test helps determine how the cells in your retinas, or rods and cones, react to light:
- Rods have greater light sensitivity than cones.
- Cones have greater sensitivity to color than rods.
The researchers found that the rods showed less response to light in those who had a genetic risk for either condition.
This study didn’t note any significant difference in how the retinal cones responded to light.
To sum up: No existing scientific evidence suggests people with bipolar disorder show any obvious or noticeable differences in eye color or shape. The idea of “bipolar eyes,” then, falls into the realm of well-worn bipolar myths.
Here are a few other myths you may have encountered.
Myth: Bipolar disorder always involves manic episodes
Truth: Manic episodes are only required for a diagnosis of bipolar 1. Other types of bipolar disorder can involve hypomania instead, which might not be as noticeable, especially when you don’t know someone well.
What’s more, around 10 percent of people may only ever have one manic episode.
Myth: Mood episodes always happen rapidly
Truth: Some people might have more than one mood episode in a day, while others may have only one or two per year.
They may also notice gradual changes in their mood and energy levels for a few days before the episode, rather than a sudden “swing” into mania or depression.
Myth: Mania feels good
Truth: If mania represents the “high” emotional state, you might reason it feels exciting, even fun, to be on top of the world, so to speak. But mania also represents a loss of control, so it’s not possible to simply “calm down” or stem the flood of energy.
Mania can lead to:
- risk taking
- impulsive decisions
- increased irritability
Any of these can affect relationships and daily life. Mania can also involve symptoms of psychosis, which can be pretty distressing.
Experts have found limited support for some eye movement changes in people living with bipolar disorder. And certainly, when you know someone well, you might pick up on slight shifts in their gaze or facial expressions.
For the most part, though, these differences aren’t all that noticeable to the average person.
When you want to support a friend or loved one with bipolar disorder, it’s generally far more helpful to pay attention to changes in their mood, rather than their eyes.
Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.