Neuro-ophthalmologic manifestations of psychogenic disease

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.