Non-organic visual loss in children

Patients with non-organic visual loss (NOVL) can take up a disproportionate amount of clinic time and clinicians often resort to expensive and prolonged investigations to ensure the correct diagnosis. This is especially the case in children.

The case notes of 30 children (18 girls, 12 boys) were retrospectively reviewed following presentation with a primary complaint of visual impairment and a diagnosis of non-organic visual loss. This figure represents 1% of new paediatric referrals to our unit. Associated symptoms included headache, periorbital pain, diplopia, photopsia and photophobia. Visual field defects were present in 5 patients and spasm of the near reflex in 1 child.

Treatment consisted of reassurance and was associated with recovery of normal visual function in all cases. Three children were referred to other health care professionals. All psychophysical, electrophysiological and neuroradiological investigations were negative.

Our study shows that non-organic visual loss is relatively common in pre-pubertal children and that this condition can be safely diagnosed using standard clinical tests in the majority of cases. Prompt diagnosis prevents unnecessary investigations and prolonged 'disease' course. Coexisting social conflict was common and may be a contributory factor. Careful explanation and reassurance to both the child and parents remains the mainstay of management.