Functional reduction of vision and visual conversion reaction ina paediatric population

Background: First case reports of psychogenic visual disorders date back in to the 19th century. Nowadays we speak of functional visual disorders of so matoform origin, a conversion reaction in which neurotic conflicts are solv ed on somatic level. This is the initial kind of reduction of aggitation sp ecially in children. In contrary to malignering and aggravation conversion symptoms are unconscious actions. Besides the problems of numerous specific tests for differential diagnosis between organic and functional disturbanc es strategies for further management are necessary. Patients and Methods: 26 patients at the age of 8-17 years with isolated re duction of vision due to conversion reaction were analyzed referring to sex , age, wether one or both eyes were affected, the duration of symptoms, the possible reasons for the conversion reaction and the further management. Results: 75% of our patients were females, the average was 12 years old, in 50% we found a bilateral involvement. The main reasons for the conversion reaction were in 30% interfamiliar problems, in 25% school problems, 2 case s (4%) occurred after mild head trauma and in 41% no reason was found. Trea tment consisted in discussions and suggestive therapy - "eyeglases" and/or "eyedrops" parents were not primarily informed the diagnosis. One to three months later the tests were repeated. 90% were without symptoms, 10% needed psychotherapy. Conclusion: Apart from comprehensive neuroophthalmologic and orthoptic exam ination it is important to observe the patient for possible doctor shopping , symptom shift and the rare development of depression.