非器质性视力下降误诊为儿童视神经炎一例分析

case analysis of non-organic visual loss misdiagnosed as optic neuritis in children

非器质性视力下降也称为心因性或功能性视力下降,除视力下降外,还可伴有视野缺损,多由于精神心理疾患导致的转换障碍引起,部分患者为诈病以获取利益。本文报道1例6岁的女性患者,主诉双眼反复视力下降1年余,早期被误诊为儿童视神经炎,给予糖皮质激素冲击治疗,治疗后稍有好转。通过本例患者误诊的教训,提醒我们在遇到儿童出现不明原因的视力下降时,在没有明确器质性疾病证据时要想到非器质性视力下降的可能,掌握识别非器质性视力下降的检查方法,不能忽略相对性传入性瞳孔障碍等基础的神经眼科检查。

Non-organic vision loss is also known as psychogenic or functional vision loss.In addition to vision loss,it can also be accompanied by visual field defects,mostly caused by conversion disorders induced by mental and psychological diseases. Some patients cheated to obtain benefits. This paper reports a 6-year-old female patient who complained of repeated visual acuity decline in both eyes for more than one year. She was misdiagnosed as pediatric optic neuritis in the early stage and treated with glucocorticoid shock therapy, and her condition improved slightly after treatment. Through the lessons learned from the misdiagnosis of this patient, we are reminded that when encountering unexplained visual impairment in children, when there is no clear evidence of organic disease, we should consider the possibility of non organic visual impairment, master the examination methods to identify non-organic visual acuity decline, and cannot ignore the basic neuro-ophthalmic examination such as relative afferent pupillary defect.