Interesting case of sudden unilateral blindness in a teenager: role of psychological intervention in psychogenic visual loss

Abstract

Visual loss complaints are commonly encountered by treating physicians, neurologist and ophthalmologists. More specifically a presentation of non-organic (psychogenic) blindness is less frequently seen but does exist and requires proper evaluation and specific skills for it to be properly managed. This case is of a 19 years old male who presented with acute monocular blindness post trauma whom he also had past psychiatric history. Post thorough assessment, no organic cause was identified, and a diagnosis of psychogenic blindness was made. Psychological therapy was beneficial in aiding return of his vision.

Sudden Mono-ocular Vision Loss in An Adolescent Female: A Case Report and Review of the Literature

“…Psychogenic blindness as a term refers to a symptomatic loss of vision which cannot be attributed to any ocular or non-ocular pathology of the visual pathway. Other terminologies that have been used to describe this concept in literature include: non-organic blindness, functional blindness, hysterical blindness, conversation syndrome and malingering [6]. In a case reported by Dutta et al, psychogenic blindness was described as a form of dissociative sensory loss, characterized by a unilateral or bilateral reduction in visual capacity or complete loss of vision, in the absence of a recognizable cause [1].…”

“…Some further techniques are described in the table below (Table 1); however, it should be noted that not all the tests are required before making a diagnosis of psychogenic blindness. These techniques are classified based on their mechanism into either: those that achieve visual acuity without the patient being aware (Group A), those that demonstrate inconsistency in patient claims (Group B) and those that objectively measure the validity of patient responses to visual stimuli (Group c) [6].…”

“…This should be followed by an explanation of the natural history of non-organic visual loss while stressing the need for adequate rest and social support for the patient [1]. The use of placebo therapies in form of eye drops or spectacles are no longer recommended as they have been said to undermine the reassurance given by the physician [6]. Negative emotions such as accusations of pretending should be avoided by family members and they should also be counseled against enforcing punitive measures on the patient [1].…”