Management of the Patient With Nonorganic Ophthalmic Disorders
After taking a detailed history and performing a thorough examination, the clinician needs to clearly document that no organic damage to the visual system was detected. In addition, the clinician should highlight any specific findings from the clinical examination and tests that confirm the inconsistencies and suggest a nonorganic etiology.
Patients with nonorganic visual disorders are best managed with understanding and encouragement. Confrontation is seldom beneficial, and it is prudent to allow patients a graceful way out by reassuring them that their disorder, while unlikely to reflect a serious condition, is a problem that will resolve over time. Often, the symptoms will clear after 1 or 2 follow-up visits, and patients should be reassured of an “excellent prognosis.” This approach is usually more effective with children than adults. Children may be further encouraged through the prescription of “eye rest”—for example, by limiting the use of electronic technology and entertainment devices.
In patients with combined organic and nonorganic (nonorganic overlay) complaints, it is best to manage the organic problem and attempt to downplay the nonorganic portion. In some cases, consultation with a psychiatrist or psychologist may be warranted for an underlying psychological illness. Finally, it is always important to monitor a patient with what initially appears to be a nonorganic visual disturbance. Occasionally, an organic disorder becomes apparent later and can be managed appropriately.
Leavitt JA. Diagnosis and management of functional visual deficits. Curr Treat Options Neurol. 2006;8(1):45–51.
Scott JA, Egan RA. Prevalence of organic neuro-ophthalmologic disease in patients with functional visual loss. Am J Ophthalmol. 2003;135(5):670–675.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.