How is hysterical blindness or malingering diagnosed?

Updated: Dec 11, 2019
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
  • Print
Answer

Hysteria/malingering

The patient with hysterical blindness or loss of vision will, despite alleged loss of vision, still be capable of maneuvering in a room. The pupillary reactions are normal. The loss of vision is a subconscious conversion symptom. A purely functional loss of vision can be assumed when the visual field is markedly constricted, orientation when walking is intact, and pupillary reactions to light are normal.

The transition between a hysterical or malingering patient and one with an aggravated loss of vision is fluid. If the patient indicates a unilateral loss of vision, the examination should be conducted in such way that the patient does not know which eye is being tested or the actual size of the optotypes, and a relative afferent pupillary defect should be present.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!