Background: Among non-organic visual disturbances, cases caused by some psychogenic factors are called conversion disorder. Such cases have poor prognosis, especially those who experience it after adolescence. Here, we report three cases of conversion disorder associated with pre-existing retinal disorders.
Patients: Case 1 was a 21-year-old woman. She experienced cataract and retinal detachment due to atopic dermatitis at the age of 15, and her best corrected visual acuity (BCVA) improved to 0.7 in both eyes after surgery. Although her postoperative course was uneventful, after the age of 17, her visual acuity decreased to hand motion (OD) and 0.01 (OS). Case 2 was a 55-year-old woman. During treatment for breast cancer, at age of 48, she had a sudden decrease in vision in the right eye (hand motion) and a subsequent decrease in vision in the left eye (0.01). Full-field electroretinogram revealed peripheral retinal vessel narrowing and abnormalities in the right eye, but no abnormality was found in the left eye. Case 3 was a 43-year-old woman. She was diagnosed with uveitis at the age of 15 with findings of secondary retinitis pigmentosa in both eyes. During the course of the disease, macular degeneration progressed in the right eye, decreasing the BCVA from 0.3 to light perception. There was no progression of macular degeneration in the left eye, but the visual acuity deteriorated to hand motion. All of the three patients had been under severe psychological stress for a long period of time, and it was thought that visual disturbances due to conversion disorder overlapped with pre-existing retinal disorders.
Conclusions: We reported cases of overlapping conversion disorder due to psychological stress caused by pre-existing retinal disorder or its progression, resulting in a significant deterioration of visual function. Similar overlaps could occur in a variety of other ocular diseases.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 128: 421-430, 2024.