Usefulness of Stereopsis Test in Psychogenic Visual Disturbance with Optic Neuritis

DOI
  • Goto Katsutoshi
    Department of Ophthalmology 1, Kawasaki Medical School
  • Mizukawa Kenichi
    Department of Ophthalmology 1, Kawasaki Medical School Shirai Eye Hospital
  • Miki Atsushi
    Department of Ophthalmology 1, Kawasaki Medical School Department of Sensory Science, Faculty of Health Science and Technology, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare
  • Setoguchi Yoshinao
    Department of Ophthalmology 1, Kawasaki Medical School
  • Araki Syunsuke
    Department of Ophthalmology 1, Kawasaki Medical School Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare
  • Haruishi Kazuko
    Department of Ophthalmology 1, Kawasaki Medical School
  • Kiryu Junichi
    Department of Ophthalmology 1, Kawasaki Medical School

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Other Title
  • 視神経炎の経過中に心因性視覚障害を合併し，その鑑別に立体視検査が有用であった1例

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Abstract

We report the case of a patient with psychogenic visual disturbance that developed during treatment for optic neuritis, and describe the use of stereopsis tests in the differential diagnosis for both conditions. A 15-year-old woman presented with chief complaint of headache, ocular pain, and acute visual loss. Her visual acuity was hand motion in the right eye and 1.5 in the left; critical flicker frequency (CFF) was immeasurable in the right eye and 40 Hz in the left; relative afferent pupillary defect was present in the right eye. Fundus examination showed optic disc swelling and redness. Hyperintensity in the right optic nerve was detected through magnetic resonance imaging (MRI) with short tau inversion recovery sequence. We diagnosed the patient with optic neuritis in her right eye. After treatment with steroid pulse therapy, we observed reduced optic disc swelling and redness. There was no improvement in visual acuity, despite the disappearance of hyperintensity in MRI of the right optic nerve, and the presence of normal latency during tests of visual evoked potential. Stereopsis tests were performed because of the discrepancy between subjective and objective tests. Titmus stereo test results were 100 seconds of stereopsis. We diagnosed the patient with a psychogenic visual disturbance that had developed during treatment of optic neuritis. Upon discharge, visual acuity and CFF in the right eye had risen to 1.5 and 43 Hz, respectively, and Goldmann perimetry measurements had improved. This case suggests that psychogenic visual disturbance should be considered a possible complication of optic neuritis, and stereopsis tests may be useful to confirm this diagnosis.

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