The prognosis of patients with hysterical visual impairment

Abstract

During the period 1962-1986, 54 patients received the diagnosis hysterical visual impairment, i.e. 1 out of every 631 patients admitted to our department. Isolated visual acuity impairment was the most common symptom, followed by combined visual acuity impairment and visual field constriction, whereas isolated visual field constriction occurred most infrequently. The mean age of the patients in the first group was significantly lower than that of the patients in the latter group. A questionnaire sent to all patients in 1987 was answered by 41 patients. Twenty-one of these (51%) felt that their visual function now was good, whereas 20 (49%) claimed that their visual function was still poor. Nine patients (22%) were disabled because of their visual problems. Twenty-nine of the patients who answered the questionnaire were re-examined. Sixteen of these (55%) still showed visual impairment at the follow-up, while 13 (45%) showed complete disappearance of visual complaints. The younger patients appeared to have a better prognosis than the older ones.

Seeing again: treatment of functional visual loss

“…Barris et al found that 78% of the 45 people in his cohort (mean age 25.9 years) showed improvement or normalisation of vision during a mean follow-up of 114 days with the use of a timetable for recovery comprising reassurance and visual exercises 11. Sletteberg et al found that 51% of the 41 people in his group reported good visual function as opposed to 49% reporting poor visual function at a mean follow-up of 2 years 12. The latter two studies also found that those aged under 16 years were more likely to recover normal visual function compared with older people.…”

Psychogenic Blindness: A Rare Presentation

“…Exact figures are lacking. 8 Of 42 patients with psychogenic or feigned visual complaints assessed by a psychiatrist in the series reported by Kathol et al, 22 (52%) were found to have psychiatric syndromes. 9 In the above mentioned case a comorbid moderate depressive episode with panic attacks were found , which definitely required psychiatric intervention for symptom relief.…”

“…7 To the contrary some authors believe that offering an eyeglass with lenses having negligible optical strength allows patients to extract themselves from psychogenic blindness without embarrassment. 8 Terms such as 'pretending' should be avoided, and punitive measures should be actively discouraged. The possibility that the symptoms may be a somatic expression of stress should also be explained, and that improved communication between family members may accelerate the visual recovery.…”

Practical clinical approaches to functional visual loss

“…Using the therapeutic approach described above, between 45% and 78% experience resolution of all visual symptoms. [27][28][29][30][31] Good prognostic indicators include young age and absence of any associated psychiatric disease. 27 Other non-specific treatments include non-medical eye drops, eye exercises, glasses or placebo medicine.…”