Background Patients with non-organic visual loss (NOVL) can take up a dispr
oportionate amount of clinic time and clinicians often resort to expensive
and prolonged investigations to ensure the correct diagnosis. This is espec
ially the case in children.
Methods The case notes of 30 children (18 girls, 12 boys) were retrospectiv
ely reviewed following presentation with a primary complaint of visual impa
irment and a diagnosis of non-organic visual loss. This figure represents 1
% of new paediatric referrals to our unit. Associated symptoms included hea
dache, periorbital pain, diplopia, photopsia and photophobia. Visual field
defects were present in 5 patients and spasm of the near reflex in 1 child.
Results Treatment consisted of reassurance and was associated with recovery
of normal visual function in all cases. Three children were referred to ot
her health care professionals. All psychophysical, electrophysiological and
neuroradiological investigations were negative.
Conclusion Our study shows that non-organic visual loss is relatively commo
n in prepubertal children and that this condition can be safely diagnosed u
sing standard clinical tests in the majority of cases. Prompt diagnosis pre
vents unnecessary investigations and prolonged 'disease' course. Coexisting
social conflict was common and may be a contributory factor. Careful expla
nation and reassurance to both the child and parents remains the mainstay o
f management.