Medically unexplained visual loss in adult patients

Abstract

Purpose To evaluate the characteristics of patients with nonorganic or medically unexplained visual loss (MUVL) presenting to a neuro-ophthalmology clinic. Methods A retrospective review of the case notes of patients identified from our diagnostic register. All patients had been followed up for at least 18 months and investigations (including, in all cases, neuroimaging) had failed to reveal any underlying pathology. To be included, patients had to have at least one inconsistent feature on visual function testing. Results: We identified 58 patients with MUVL.

Medically unexplained visual symptoms in children and adolescents: an indicator of abuse or adversity?

“…Medically unexplained visual symptoms in adults are well described. 2 In children (and adults), MUS may be associated with childhood adversity, neglect and abuse, particularly sexual abuse 5 as in one of our cases. It is for this reason that it is particularly important that MUS are positively identified so that causes of the underlying psychological distress can be considered.…”

Functional vision loss

“…blur and visual field constriction) are examples. Pain syndromes are not categorized as conversion disorders, although pain and dysesthesias often accompany them [1,3,4]. In contrast to the DSM, the ICD lists conversion disorder as a dissociative disorder.…”

“…With that in mind, ingenious techniques have been described to uncover functional vision loss. Table 1 summarizes some of the widely known tests for evaluating functional vision loss previously reported in detail by others [13 && , [14][15][16][17][18]. Next, we review some techniques for uncovering FVL which have been more recently described.…”

“…For this reason, upon first encounter, the less presumptive term medically unexplained visual loss may be more prudent [1]. Once the nature of the underlying visual problem is determined to be nonorganic, specific nomenclature helps to categorize it further.…”

“…In these cases, both eyes are usually affected to the same degree. Eyes which are unilaterally involved tend to be worse than when both eyes are affected [1]. Decreased visual acuity and constricted visual fields are the most common symptoms.…”