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An atypical presentation of functional visual loss: A case report
Junkyu Chung1, Kyung Hyun Jin, Jaheon Kang
1Department of Ophthalmology, Kyung Hee University Hospital at Gangdong Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea.
Medicine
|October 12, 2017
Summary
Functional visual loss (FVL) can present with unusual visual field defects. This case highlights simultaneous binasal and homonymous hemianopsia in FVL, emphasizing the need for thorough examination when organic causes are absent.
Area of Science:
- Ophthalmology
- Neurology
- Psychiatry
Background:
- Functional visual loss (FVL) presents with diverse symptoms, most commonly reduced visual acuity and visual field defects.
- Hemianopsia is a rare manifestation of FVL, necessitating exclusion of organic pathology through comprehensive evaluation.
- Atypical presentations of FVL require meticulous history taking and diagnostic examinations.
Observation:
- A 48-year-old male experienced decreased visual acuity and visual field defects post-traffic accident.
- Initial visual field testing revealed binasal hemianopsia.
- Brain imaging (CT and MRI) showed no structural abnormalities.
Findings:
- The patient's visual field defect evolved from binasal hemianopsia to left homonymous hemianopsia within two weeks.
- Best corrected visual acuity was 20/63 in both eyes.
- Diagnosis of FVL was established, attributed to conversion disorder.
Implications:
- Simultaneous occurrence of binasal and homonymous hemianopsia is rare but possible in FVL.
- FVL should be suspected in cases of atypical visual field defects without organic findings.
- Repeated Humphrey field testing and visual evoked potential (VEP) can aid in diagnosing FVL.
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