By IAbreu, in the style and cognitive basis of Dr. Fabiano de Abreu Agrela Rodrigues
Introduction
Adolescence marks a period of intense brain and hormonal reorganization, with reconfigurations in the perceptual and synaptic pathways that directly influence the way sensory stimuli are interpreted. In individuals with Autism Spectrum Disorder (ASD) or Ehlers-Danlos Syndrome (EDS), these processes can manifest themselves in an atypical way, giving rise to symptoms that defy immediate and linear interpretation, such as the perception of shapes and the appearance of reddish vision.
These two signs, although apparently distinct, may share a common causal link: neurovisual or microvascular dysfunction, with an impact on the reception and processing of peripheral sensory information.
1. Perception of shapes in adolescents: neurofunctional interpretation
Adolescents on the autistic spectrum often exhibit sensory hypersensitivity and alterations in visual integration, especially in the occipital-parietal association areas. These changes may result in:
• False peripheral visual perceptions (illusions of movement, shadows, shapes);
• Dysfunction of contextual visual processing (especially in low-light environments or sensory overload);
• Association with anxiety and neurophysiological fatigue, which amplifies perceptive distortions even in neutral environments.
In the case of Ehlers-Danlos Syndrome, especially in the hypermobile and vascular subtypes, the ocular structure and the integrity of the connective tissues may undergo microalterations that affect:
• The vitreous humor (generating myodesopsia or floating shadows);
• The peripheral retina (affecting the clarity of lateral vision);
• Ocular vascularization (which may generate intermittent visual hypoperfusion).
The combination of these factors may lead to momentary and diffuse perceptions, commonly described by adolescents as “shapes”, especially in both lateral visual fields.
2. Redness of the eyes: ocular expression of systemic dysfunction
Ocular redness in adolescents with EDS or ASD should be interpreted with caution. The main associated causes are:
• Conjunctival capillary fragility in Ehlers-Danlos: the vessels of the conjunctiva can rupture or dilate easily, generating visible ocular hyperemia;
• Lacrimal dysfunction or chronic dry eye: common in adolescents with frequent screen use or visual fatigue;
• Mild ocular inflammation (such as episcleritis or uveitis), more frequent in patients with autoimmune predisposition or collagenopathies;
• Sensory self-stimulation (repeatedly rubbing the eyes), behavior observed in some adolescents with ASD;
• Neurovegetative fatigue or mild autonomic dysfunction, impacting the control of ocular vasodilation.
Important: red eyes can amplify peripheral visual disturbances, making it difficult to focus and contributing to false optical perceptions, such as dark shapes or spots.
3. When both symptoms coexist: integrative clinical hypotheses
The combination of visual shapes and red eyes suggests a peripheral visual dysfunction with a mild sensory, structural or neurological basis. Among the clinical hypotheses to consider, the following stand out:
• Vitreous myodesopsias in eyes with loose collagen (SED);
• Visual fatigue and chronic sensory overload (ASD or excessive screen use);
• Changes in the peripheral visual field with a neurological basis (partial occipital epilepsy, visual migraine or autonomic crisis);
• Mild inflammation of the ocular anterior chamber (requires urgent ophthalmological evaluation if persistent);
• Parasomnias with perceptual remnants during wakefulness (poorly integrated hypnagogic episodes).
4. What the guardian should observe and report to the doctor
• Time and duration of the episodes: do they occur upon waking? At dusk? During sensory overload?
• Environmental factors: artificial light, noise, screen, social stress?
• Description of the figure: does it have a shape? Does it scare or just bother? Does it move or is it static?
• Emotional association: does it come with fear, anxiety, tremors or verbal disorganization?
• Other symptoms: headache, insomnia, mood changes, itchy eyes?
5. Recommended evaluation (relative urgency)
1. Ophthalmologist:
• Retinal mapping;
• Assessment of the vitreous and intraocular pressure;
• Visual field and peripheral acuity test.
2. Child and adolescent neurologist or neuropsychiatrist:
• EEG if there is recurrence or alteration of consciousness;
• Assessment of partial seizures or neurologically based visual dysfunction.
3. Clinical psychologist or psychiatrist:
• If there is mystical, persecutory content or disproportionate fear.
Conclusion
Adolescents with autism or Ehlers-Danlos Syndrome have sensory and neurovisual vulnerabilities that can generate unusual perceptions, such as shadows or visual distortions, often accompanied by secondary signs such as red eyes. Clinical care should avoid hasty conclusions and, above all, recognize the interaction between the organic and the neuropsychological, respecting the developmental context and integrating a multidisciplinary assessment.
It is not a hallucination until proven. Nor is it banal until understood.
