Hysterical Amblyopia

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Hysterical Amblyopia is a syndrome that is characterized by reduced visual acuity not caused by any type of eye disease.  It is 4 times more prevalent in girls and shows a peak in incidence between the ages of 11 to 14. A number of symptoms cluster together, with vision changes noticed first at near distances when reading, often with a sudden onset. In some children there may be no complaints about vision even with marked reductions in vision. Accompanying the reduced vision there is frequently a lowering of depth perception as tested by stereoscopic methods, a reduction in color vision test scores, and tunnel vision. When tunnel vision is present it is in a form that is not possible from a physiological perspective, and there is no corresponding loss of peripheral mobility (the child is not bumping into objects as they walk. It can be a result of stress in the child’s environment. Other symptoms may be present such as headaches and light sensitivity.

Streff Syndrome is used to describe similar problems that are thought to be caused by the visual stress of near work. Some Eye Doctors make a sharp distinction between the two conditions, I feel they are the same, caused by stress whether it is in the family environment, related to intense near work, or both.

Treatment opinions vary greatly. Visiting a therapist to rule out any serious psychological issues in a good step. Various forms of lenses and tints may be used. Some Optometrist believe low prescriptions to help the eye focus are useful. I believe these are usually placebo effects but fall in the category of active placebos. A school of thought exists that not all placebos are equal and choosing  the correct placebo can aid in healing a number of health problems. Frequently the lens and tint options we use can resolve the problem in a matter of weeks or months. Sometimes eye exercises are used. Occasionally drops are used. Other alternative therapies can be used, the most well known being the Irlen System. However, I have found the tints we use to be just as effective.

Malingering occurs when a child wants glasses and feigns vision loss. It is difficult for a child to be successful malingering with the eye exams we utilize today. Hysterical Amblyobia is not malingering, it is a true psychologically related vision loss. Left untreated hysterical amblyopia may continue throughout life. It may also spontaneously disaapear as stress reduces.

It is vitally important to follow up with appoinments and make sure the condition is not getting worse. I have seen one case of hysterical ambyopia tha occurred at the same time a pituitary tumor was developing. Follow up visits allow us to make sure that no rare cases of co-exsisting serious conditions exsist. Although it is normally done only at research centers, electrophysiological testing can help in the definitive diagnosis of hysterical amblyopia.

Comments 3

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    Interesting but I am not a teenager. Has been suggested that a SUDDEN change in my eyesight could have been the result of a fatal car accident I was involved in as an innocent party. I have had an eye test showing little change since 2010, accident 26.01.11 – photographs of eye show healthy eyes, similar to 2005 pics, pressure good etc. so is this hysterical amblyopia or could it be something else?

  3. Post

    Hi Sue,

    That is a hard thing to go through. There is a lot of ambiguity on hysterical amblyopia, Streff Syndrome, and other names for psychological or trauma induced vision loss. You certainly could have a form of mental trauma related vision loss. Being a teen is not a prerequisite, it is just much more common in that age group. The hallmark of hysterical (or functional versus pathological disease caused vision loss) amblyopia is evidence of tunnel vision and low acuity with no signs of peripheral disability. In plain english:
    *There is no known disease that causes true tunnel vision. If you cover one eye and bring in a small object from the side at some point you will see it. If you try this again with the object twice as far away you should be able to see it twice as far out-the field of vision is a cone that expands. With tunnel vision it is the same distance out no matter how far away the object is held. With this type of tunnel people would be running into things all the time. With functional vision loss they don’t. This can be tested on an old fashion test called a tangent screen or just by a small object. If that is the case it can be treated with therapy. I have heard very good things about Eye movement desensitization and reprocessing (EMDR). It sounds like voodoo but seems to work well and be a brief type of therapy people who have has incidents of severe emotional trauma. Physical trauma to the optic nerve, brain, or even massive blood loss can cause sudden vision loss but I am presuming they have done an MRI and ruled all of this out. There is very limited understanding of functional vision loss so don’t let anyone try to convince you that you have a “mental defect”. It may end up being related to a massive release of neurotransmitters at the time of trauma that resets something, who knows. There is even some limited evidence that has found trying to relive the incident and come to “terms with it” is actually harmful. If you have a clean bill of health you might want to try looking for a psychologist who specializes in brief EMDR therapy.

    Best Wishes

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