What question did this study set out to answer?

Evaluate psychiatric outcomes following eye removal and compare these by surgical indication.

February 12, 2026

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

Key Points

Evaluate psychiatric outcomes following eye removal and compare these by surgical indication.
Retrospective cohort analysis of patient records from TriNetX Research Network
Comparison of psychiatric outcomes in 20,109 eye removal patients versus 325,108 other surgeries
Patients propensity-score matched by surgical aetiology
Utilized Cox proportional hazards models to assess predictors of psychiatric outcomes
Higher rates of antidepressant use in eye removal cohort (RR 1.14; p<0.01)
Higher rates of anxiolytic use in eye removal cohort (RR 1.15; p<0.01)
Trauma-related eye removal associated with higher risk of depression (RR 1.85; p=0.03)
Trauma-related cases had increased antidepressant use (RR 2.18; p<0.01) and anxiolytic use (RR 1.63; p<0.01)
Trauma remained an independent predictor of depression after adjusting for history (HR 1.34; p<0.01).

Abstract

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 20 109 patients who underwent EE. Psychiatric outcomes were compared with 325 108 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. Trauma-related EE carries a distinctly higher psychiatric burden, supporting the need for targeted mental health screening and intervention in this vulnerable subgroup.

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