Bipolar disorder is a complex mental health condition characterized by a potential breadth of both manic and depressive symptoms, such as a euphoric mood and decreased need for sleep, shifting to loss of interest in activities, difficulty concentrating, and feeling hopeless. It can be challenging to detect when these changes, known as mood episodes, are happening, but for some with bipolar, differences in their eyes may be a telltale sign.
This effect, known colloquially as “bipolar eyes,” doesn’t happen to everyone and isn’t considered a hallmark symptom of the condition. However, it may be noticeable during a manic episode for some, says the psychiatrist Alex Dimitriu, MD, founder of Menlo Park Psychiatry and Sleep Medicine in California, and a medical reviewer at Everyday Health.
“‘Bipolar eyes’ is a nonclinical term used to describe the look of someone in a manic episode, where the eyes convey excess energy or excitement,” he says. But, changes in eye appearance are just one potential part of a bigger picture when it comes to diagnosing and managing bipolar disorder.
With a manic episode in bipolar disorder, increased levels of norepinephrine and dopamine flow through the body, says Dr. Dimitriu. Levels of glutamate also increase during an episode.
These substances are natural chemical messengers (neurotransmitters) that play significant roles in mood, attention, memory, and perceptions of reward. When they’re elevated, a person tends to seem much more energized and excited, which can be reflected in how their eyes appear, he says. According to Dimitriu, this can result in:
Dilated pupils
An intense stare
Eyes that may change color or look darker due to larger pupils
Rapidly darting eye movements
Reduced blinking
Smaller eyelids since eyes are open wider
Eyes that seem sparkling
“With the eyes like this, people can appear agitated and more alert,” he says. “That effect can be heightened with other signs of physical hyperactivity.” For instance, someone with “bipolar eyes” may seem to have trouble sitting still and be constantly fidgeting.
The term is usually used for manic episodes, but “bipolar eyes” can refer to changes during depressive episodes as well, says Dimitriu.
"During depression, eyes might have the opposite effect,” he says. “Pupils can become small and eyelids may seem heavier. People might look tired and lose the ‘gleam’ in their eyes. Their gaze may involve avoiding eye contact and looking off to the side.”
As mentioned, although “bipolar eyes” may appear during a mood episode, especially mania, the hallmark symptoms of manic or depressive episodes are likely occurring, too. Common symptoms of a manic episode may include:
Noticeably increased euphoria, energy, or irritability
Grandiosity, or an exaggerated sense of self-confidence or well-being
Reduced need for sleep
Unusual talkativeness or rapid speech
Racing thoughts or easy distractability
Increased impulsive behaviors
Poor or risky decision-making, such as going on shopping sprees or having risky sex
Common symptoms of a depressive episode may include:
Sad or depressed mood
Loss of interest or pleasure in usual activities
Sleeping too little or too much
Appetite changes that result in unintentional weight gain or loss
Although research on eye appearance with bipolar disorder is limited, some research shows associations between bipolar disorder and changes in eye function.
For example, in one study on schizophrenia and bipolar disorder, researchers evaluated eye-tracking tasks, called vergence eye movements. These involve the eyes moving in different directions to maintain focus on an object as its distance from the subject changes. In the research, those with bipolar showed difficulty with coordinating their eye movements to follow the object effectively, in part because they tended to have more rapid, jerky eye movements rather than smooth, coordinated ones.
More research is still needed to learn about potential eye changes that can happen in people with bipolar disorder.
Although “bipolar eyes” is not a clinical term, the type of brain chemical changes experienced during bipolar episodes, which can cause changes in eye appearance, are indeed a real thing. The best way to manage these chemical changes is through medical treatment.
The surge and drop in norepinephrine, dopamine, and other brain chemicals are the focus of medications for the condition, since they can influence these neurotransmitters, says Hilary Blumberg, MD, director of the Mood Disorders Research Program and professor of psychiatry at Yale School of Medicine in New Haven, Connecticut.
However, if the presence of “bipolar eyes” makes you or your loved one feel like their bipolar disorder isn’t being adequately managed, talk to your doctor about other treatment options you could try, she says. That’s especially true if they’re accompanied by other symptoms that seem intense or severe, says Dimitriu.
“There can be a misconception that there are limited treatments available for bipolar disorder,” says Dr. Blumberg. “Sometimes staying on the same medication is possible with a change in dose or a way to minimize the side effects, but there are also now multiple different types of medications that can be effective.”
Several non-medication interventions can also be helpful alongside medication, including talk therapy and therapies that provide behavioral strategies such as changing sleep patterns and helping to educate and engage support systems, Blumberg adds.
“With many treatment options out there, there is often hope to find improved ways to feel better,” she says.
Due to changes in brain chemicals during a manic episode of bipolar disorder, there may be a change in the appearance and function of the eyes.
Depressive episodes may lead to some eye changes as well, such as smaller pupils and heavier eyelids.
“Bipolar eyes” is not a clinical term, but it may be helpful in assessing whether there is a change in bipolar symptoms.
