Mental Health Disorders and Comorbid Substance Use Disorder as Risk Factors for Ophthalmic Trauma

Abstract Background/Objectives : Ophthalmic trauma is a leading cause of monocular blindness, yet psychosocial risk factors remain poorly characterised. We evaluated whether preexisting mental health disorders (MHD) and comorbid substance use disorder (SUD) raise the risk of ocular and orbital injury. Subjects/Methods : Retrospective cohort study of de-identified records from 111 healthcare organisations in the TriNetX network, January 2010 to January 2025. Adults aged ≥ 18 with a documented general adult medical examination were identified by ICD-10 codes; those with prior ocular malignancy, major ocular surgery or the study outcomes were excluded. The primary analysis compared patients with MHD and comorbid SUD against patients with MHD alone; the secondary compared patients with MHD against matched controls, stratified by sex. After one-to-one propensity score matching, hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 6 months, 1 year and 1.5 years. Results : The substance use comparison matched 3.87 million patients per cohort, the sex stratified comparison 2.39 million males and 3.03 million females. At 1.5 years, comorbid SUD raised risk across all five categories, from HR 1.161 (95% CI 1.124–1.199) for corneal abrasion to 1.485 (1.170–1.885) for penetrating wound with foreign body. Preexisting MHD raised risk in both sexes at every interval, largest for contusion of eyeball and orbital tissue, 2.894 (2.640–3.173) in males and 2.643 (2.439–2.863) in females. Conclusions : Preexisting MHD is associated with increased risk of ocular and orbital injury, and comorbid SUD confers additional risk. Screening and timely referral may reduce ocular injury burden in at-risk populations.