Decreased Visual Acuity and Diplopia in a Patient with Münchausen Syndrome

Numata-Watanabe, Konomi; Hayasaka, Seiji; Kadoi, Chiharu; Ikeda, Nariko

doi:10.1159/000027320

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…As Thompson [10] described, the impaired function is presumably fully restorable because the impairment is a matter of function rather than of structure. Patients with functional visual loss, therefore, may have many different underlying conditions, and many terms have been used in the literature to attribute functional visual loss to an underlying motive or cause such as hysteria, psychogenic disorder, conversion disorder, Münchausen syndrome, hypochondria, somatization disorder or malingering [10, 11, 12]. In our case, a true underlying condition was not clear.…”

Section: Discussionmentioning

confidence: 92%

A Case of Functional (Psychogenic) Monocular Hemianopia Analyzed by Measurement of Hemifield Visual Evoked Potentials

Yoneda

Fukuda

Nishimura

et al. 2013

Case Rep Ophthalmol

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Purpose: Functional monocular hemianopia is an extremely rare condition, for which measurement of hemifield visual evoked potentials (VEPs) has not been previously described. Methods: A 14-year-old boy with functional monocular hemianopia was followed up with Goldmann perimetry and measurement of hemifield and full-field VEPs. Results: The patient had a history of monocular temporal hemianopia of the right eye following headache, nausea and ague. There was no relative afferent pupillary defect, and a color perception test was normal. Goldmann perimetry revealed a vertical monocular temporal hemianopia of the right eye; the hemianopia on the right was also detected with a binocular visual field test. Computed tomography, magnetic resonance imaging (MRI) and MR angiography of the brain including the optic chiasm as well as orbital MRI revealed no abnormalities. On the basis of these results, we diagnosed the patient's condition as functional monocular hemianopia. Pattern VEPs according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standard were within the normal range. The hemifield pattern VEPs for the right eye showed a symmetrical latency and amplitude for nasal and temporal hemifield stimulation. One month later, the visual field defect of the patient spontaneously disappeared. Conclusions: The latency and amplitude of hemifield VEPs for a patient with functional monocular hemianopia were normal. Measurement of hemifield VEPs may thus provide an objective tool for distinguishing functional hemianopia from hemifield loss caused by an organic lesion.

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Section: Discussionmentioning

confidence: 92%

A Case of Functional (Psychogenic) Monocular Hemianopia Analyzed by Measurement of Hemifield Visual Evoked Potentials

Yoneda

Fukuda

Nishimura

et al. 2013

Case Rep Ophthalmol

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“…We are unaware of any previously reported cases of Munchausen syndrome induced by introduction of ant’s particles into the conjunctival fornices. Self-inflicted eye damage has been described mainly in girls and young women 3, 4, 6, 9. Our patient is 18 years old healthy girl.…”

Section: Discussionmentioning

confidence: 89%

“…Ocular Munchausen Syndrome is uncommon. Reported manifestations include orbital emphysema requiring exenteration, periorbital abscesses, subconjunctival hemorrhages, keratoconjuctivitis due to calcareous concretions, superficial punctate keratophathy, corneal alkali burns, intractable corneal erosions, nystagmus, mydriasis, decreased visual acuity, diplopia, and eye perforation 3, 4, 5, 6, 7, 8, 9. We are unaware of any previously reported cases of Munchausen syndrome induced by introduction of ant’s particles into the conjunctival fornices.…”

Section: Discussionmentioning

confidence: 99%

Ocular Munchausen’s Syndrome induced by introduction of ant’s particles into the conjunctival fornices

Ghadeer

Othaimeen

Amry

2018

Saudi Journal of Ophthalmology

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Munchausen’s Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculation of ant’s particles inside her conjunctival fornices of both eyes. The crushed particles was confirmed to be crushed ant’s particles. Munchausen Syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnoses when ocular abnormalities cannot be explained. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist.

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“…As Thompson [1] wrote, "The impairment is a matter of function rather than structure, and hence that function is presumably fully restorable." Many terms have been used throughout the literature for functional visual loss, such as malingering [2], hysteria [2], conversion disorder [1], Munchausen's syndrome [3], hypochondria [1], or somatization disorder, which have attempted to attribute an underlying cause or motive for the visual changes. Malingering, for example, implies that visual symptoms are deliberately fabricated in an effort to extort a financial or other secondary gain.…”

Section: Introductionmentioning

confidence: 99%

Functional visual loss

Shindler

Galetta²,

Volpe³

2004

Curr Treat Options Neurol

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Patients who present with visual loss that cannot be explained by organic lesions represent a wide spectrum of patients from those with no physiologic problem to those patients who have a true underlying condition. Regardless of where a patient falls within this spectrum, all patients need to be approached with a clinical evaluation to ensure that no underlying physiologic deficit exists. After excluding organic causes with appropriate examination and testing, a patient's visual loss still should not be labeled as functional until it is proven that they can see better than they claim to see. Only after convincingly demonstrating better vision can the physician begin to consider treatment options to help the patient's vision recover. Although functional visual loss places the physician in an unusual adversarial position of refuting a patient's symptoms, exposing the patient in a confrontational manner rarely helps. Instead, an approach that allows patients to resolve the symptoms on their own through reassurance and support often leads to successful restoration of vision. Reassurance that their condition is not serious, and may recover with time, allows patients to slowly admit their vision is improving without ever suggesting that the concern and medical attention they sought was unwarranted.

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Decreased Visual Acuity and Diplopia in a Patient with Münchausen Syndrome

Cited by 6 publications

References 8 publications

A Case of Functional (Psychogenic) Monocular Hemianopia Analyzed by Measurement of Hemifield Visual Evoked Potentials

A Case of Functional (Psychogenic) Monocular Hemianopia Analyzed by Measurement of Hemifield Visual Evoked Potentials

Ocular Munchausen’s Syndrome induced by introduction of ant’s particles into the conjunctival fornices

Functional visual loss

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