Langmann A, Lindner S, Kriechbaum N
Univ.-Augenklinik Graz, Auenbruggerplatz 4, 8036 Graz, Osterreich.
Klin Monbl Augenheilkd. 2001 Oct;218(10):677-81. doi: 10.1055/s-2001-18390.
First case reports of psychogenic visual disorders date back into the 19th century. Nowadays we speak of functional visual disorders of somatoform origin, a conversion reaction in which neurotic conflicts are solved on somatic level. This is the initial kind of reduction of agitation specially in children. In contrary to malingering and aggravation conversion symptoms are unconscious actions. Besides the problems of numerous specific tests for differential diagnosis between organic and functional disturbances strategies for further management are necessary.
26 patients at the age of 8 - 17 years with isolated reduction of vision due to conversion reaction were analyzed referring to sex, age, wether one or both eyes were affected, the duration of symptoms, the possible reasons for the conversion reaction and the further management.
75 % of our patients were females, the average was 12 years old, in 50 % we found a bilateral involvement. The main reasons for the conversion reaction were in 30 % interfamiliar problems, in 25 % school problems, 2 cases (4 %) occurred after mild head trauma and in 41 % no reason was found. Treatment consisted in discussions and suggestive therapy - "eyeglasses" and/or "eyedrops" parents were not primarily informed the diagnosis. One to three months later the tests were repeated. 90 % were without symptoms, 10 % needed psychotherapy.
Apart from comprehensive neuroophthalmologic and orthoptic examination it is important to observe the patient for possible doctor shopping, symptom shift and the rare development of depression.
心因性视觉障碍的首例病例报告可追溯到19世纪。如今，我们提及的是躯体形式起源的功能性视觉障碍，这是一种转换反应，其中神经症冲突在躯体层面得到解决。这是特别是在儿童中最初出现的一种焦虑缓解方式。与诈病和病情加重相反，转换症状是无意识行为。除了用于鉴别器质性和功能性障碍的众多特定检查存在的问题外，还需要进一步管理的策略。
分析了26例年龄在8至17岁因转换反应导致视力单独下降的患者，涉及性别、年龄、单眼或双眼是否受累、症状持续时间、转换反应的可能原因以及进一步的管理情况。
我们的患者中有75%为女性，平均年龄为12岁，50%的患者双眼受累。转换反应的主要原因中，30%是家庭内部问题，25%是学校问题，2例（4%）发生在轻度头部外伤后，41%未发现原因。治疗包括讨论和暗示疗法——未首先告知家长“眼镜”和/或“眼药水”的诊断情况。一至三个月后重复进行检查。90%的患者无症状，10%需要心理治疗。
除了全面的神经眼科和斜视检查外，观察患者是否可能存在反复就医、症状转移以及罕见的抑郁发展情况也很重要。
