Semin Neurol 2006; 26(3): 310-320
DOI: 10.1055/s-2006-945517
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Neuro-Ophthalmologic Manifestations of Psychogenic Disease

Neil R. Miller1
  • 1Professor of Ophthalmology, Neurology, and Neurosurgery, Frank B. Walsh Professor of Neuro-Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Further Information

Publication History

Publication Date:
22 June 2006 (online)

ABSTRACT

From a neuro-ophthalmologic standpoint, five areas may be affected by psychogenic disease: (1) vision, including visual acuity and visual field; (2) ocular motility and alignment; (3) pupillary size and reactivity; (4) eyelid position and function; and (5) corneal and facial sensation. The physician faced with a patient complaining of decreased vision or some other disturbance related to the afferent or efferent visual systems for which there is no apparent biologic explanation has three responsibilities. First, the physician must ascertain that an organic disorder is not present. Second, the physician should induce the patient to see or do something that would not be possible if the condition were organic in nature. Finally, the physician should attempt to determine whether the patient has an underlying psychiatric disease or is experiencing psychosocial stress. In this article, manifestations of psychogenic disease as they pertain to vision are considered, and, where appropriate, the various methods used to diagnose and treat these phenomena are discussed.

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Neil R MillerM.D. 

Maumenee B-109, Wilmer Eye Institute, The Johns Hopkins Hospital

600 North Wolfe Street, Baltimore, MD 21287

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