Nonorganic visual loss and associated psychopathology in children

To report the frequency of nonorganic visual loss (NOVL) and associated psychopathology in children.

A total of 973 children were examined in our ophthalmology practice between 2006 and 2009. Basic ophthalmologic exploration (visual acuity, stereopsis, cycloplegic refraction, ocular motility, pupil dynamics, biomicroscopy, indirect ophthalmoscopy) and specific tests for NOVL diagnosis were performed (confusion with lenses test, mirrors test, Roth test, Bravais test). We also investigated the psychosocial situation and associated psychiatric problems.

Thirty children were diagnosed with NOVL. The mean age of the children was 8.93 years (± 2.61); 70% were girls. September was the commonest month of presentation (26.7%) and unilateral (3.3%) or bilateral (80%) visual loss was the most frequent symptom (83.3% in total). In 20% of cases we detected psychosocial anomaly and 40% were seeking to wear glasses.

Malingering in children is very frequent. We can make the diagnosis with simple tests. It is not necessary to perform imaging and electrophysiologic testing, thus avoiding unnecessary examinations as well as absenteeism from work for parents and health care costs.