A review of ocular malingering and hysteria for the flight surgeon

Malingering is the conscious creation of a functional defect or denial of a true defect. Positive malingering is the former, and negative malingering is the latter. Hysteria is similar to malingering except that it is unconscious. Ocular malingering is common among draft evaders. The flight surgeon or military ophthalmologist will more commonly see the negative malingerer in peacetime because of the high physical standards for flying. Wartime creates a sudden shift towards positive malingering, however, for obvious reasons. This paper carefully defines the distinctions between malingering, hysteria, and true disease consistent with the defect claimed. It also provides a systematic approach to history, examination, and special testing of a possible ocular malingerer/hysteric. A number of common ocular complaints are considered separately, including decreased visual acuity, visual field defects, night vision defects, color vision defects, ocular muscle defects, automutilatory defects, opacification of transparent media, blepharospasm, intraocular disease, and asthenopia.