Ocular and systemic melatonin and the influence of light exposure

Melatonin is a neurohormone known to modulate a wide range of circadian functions, including sleep. The synthesis and release of melatonin from the pineal gland is heavily influenced by light stimulation of the retina, particularly through the intrinsically photosensitive retinal ganglion cells. Melatonin is also synthesised within the eye, although to a much lesser extent than in the pineal gland. Melatonin acts directly on ocular structures to mediate a variety of diurnal rhythms and physiological processes within the eye. The interactions between melatonin, the eye, and visual function have been the subject of a considerable body of recent research. This review is intended to provide a broad introduction for eye-care practitioners and researchers to the topic of melatonin and the eye. The first half of the review describes the anatomy and physiology of melatonin production: how visual inputs affect the pineal production of melatonin; how melatonin is involved in a variety of diurnal rhythms within the eye, including photoreceptor disc shedding, neuronal sensitivity, and intraocular pressure control; and melatonin production and physiological roles in retina, ciliary body, lens and cornea. The second half of the review describes clinical implications of light/melatonin interactions. These include light exposure and photoreceptor contributions in melatonin suppression, leading to consideration of how blue blockers, cataract, and light therapy might affect sleep and mood in patients. Additionally, the interactions between melatonin, sleep and refractive error development are discussed. A better understanding of environmental factors that affect melatonin and subsequent effects on physiological processes will allow clinicians to develop treatments and recommend modifiable behaviours to improve sleep, increase daytime alertness, and regulate ocular and systemic processes related to melatonin.