Optic Neuropathy with Functional Overlay

Dr. Jason Peragallo discusses a patient with a brain tumor and optic neuropathy who experienced sudden vision loss in one eye but exhibited a small relative afferent pupillary defect. An OKN drum test and mirror exercise showed response in the affected eye, which revealed a functional overlay on top of the optic neuropathy. Management involved educating the patient that the condition is a functional neurologic symptom disorder without structural damage. This provided the patient with a diagnosis without stigma, and the possibility of improvement and recovery of vision over time. In such cases, the patient can be treated for any underlying ophthalmic condition if they have one and with psychotherapy or a multidisciplinary patient program.