Nonorganic Visual Disorders

NOVL is a manifestation of malingering, conversion disorder, and rarely factitious disorder. Triggers include emotional stress, a life-changing event, trauma, or depression and anxiety. NOVL can be seen in children and adults and most commonly manifests as loss of vision or visual field or combinations of both. Other manifestations of NOVL include eye movement abnormalities, facial and pupil changes. The goal of the physician is to perform a complete ophthalmic examination to look for an underlying disease as there may be a functional overlay in some patients with the true disease. If none is detected, nonphysiological findings should be looked for using prisms, refractive tricks, stereopsis tools, special lenses, kinetic visual field testing. OCT, VEP, and ERG may be performed to document normal optic nerve and retinal structure and function. If necessary, neuroimaging can be obtained in patients who are uncooperative, have other nonocular symptoms, are suspected of having the true disease, or who may need reassurance. Further studies with fMRI may help clarify the mechanism of functional visual loss as it relates to conversion disorder. The management typically involves maintaining an empathetic tone and reassurance. Prognosis generally is favorable in conversion disorder may be limited in malingers, especially if it pertains to a legal matter.