Conversion visual loss: a differential diagnosis in infant amblyopia.

Carlos Laria, Maria Elena Perez, Eduardo Perez, David Pablo Pinero, José Maria Ruiz-Moreno, Jorge L Aliò

Index: Eur. J. Ophthalmol. 19(6) , 1065-8, (2009)

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Abstract

To report the first case of amblyopia due to a conversion disorder in a child.A 9-year-old girl without allergies or family or personal antecedents of interest presented to our clinic. She manifested a progressive visual loss after an episode of lumbar pain. This progressive loss led the patient in a 6-month period to legal bilateral blindness: visual acuity inferior to 2/20 in both eyes and severe constriction of both visual fields.Several pathologic processes were discarded by means of multiple explorations and a general multidisciplinary analysis: physical pathology, simulating patient, schizophrenia, and the Briquet syndrome. Finally, she was diagnosed with a conversion somatoform disorder leading to a bilateral blindness. For 6 months, the patient was successfully treated with psychotherapy and a pharmacologic protocol. Total recovery was achieved with final visual acuity of 20/20 in both eyes and normal visual fields.Conversion disorders should be considered as an additional etiology of visual loss in children. In these cases, the analysis and multidisciplinary treatment is crucial for a successful outcome.