18例儿童癔病性弱视的临床特征分析

Hysterical amblyopia in 18 children:Causes,clinical manifestation,examination and management

  • 摘要: 目的 分析儿童癔病性弱视的疾病诱因、临床表现、眼科检查、治疗过程,提高临床医生对该病的认识。方法 收集2017年3月-2019年6月于解放军总医院第一医学中心眼科就诊的18例儿童癔病性弱视患者临床资料,分析疾病诱因、患儿主诉、主观视力检查、裂隙灯检查、眼底照相、光学相干断层扫描(optical coherence tomography,OCT)、视野、图形视觉诱发电位(pattern visual evoked potential,P-VEP)以及治疗过程。结果 18例诊断为儿童癔病性弱视患者,年龄8 ~ 12岁,平均9.83岁,其中男孩6例,女孩12例。患者均以视力下降为主诉,其中17例为双眼,1例为单眼,3例伴有复视。发病之前均可以找到诱发因素,其中2例既往与父母关系紧张,4例曾受老师体罚,3例有外伤史,9例既往家庭成员增加(其中2例伴有发热史、1例伴外伤史)。眼科检查患眼主观视力为0.15 ~ 0.5,平均0.30,6例视野向心性缩窄伴P-VEP检查双眼P100波峰时值轻度延迟;其余检查结果无异常。6例既往误诊为"视神经炎"患者中,4例有外伤史,2例有家庭成员增加且伴有发热史。18例中,3例住院行心理暗示及营养神经等治疗,其余患者门诊行心理疏导、心理暗示后视力提高至正常。随诊1个月视力无异常。结论 儿童癔病性弱视具有潜在心理诱因,主客观眼科相关检查结果分离,外伤和发热容易导致误诊。

     

    Abstract: Objective To analyze the precipitating factors,patients' chief complaints,subjective and objective ophthalmology examinations and treatments of hysterical amblyopia in children,so as to improve the clinicians' understanding to this disease. Methods From March 2017 to June 2019,clinical data about 18 children with hysterical amblyopia admitted to the First Medical Center of Chinese PLA General Hospital were collected and analyzed,including disease precipitating factors,patients' chief complaints,subjective vision test,slit lamp test,fundus photography,optical coherence tomography (OCT),visual field,pattern visual evoked potential (P-VEP) and the treatment. Results Of the 18 cases,there were 6 males and 12 females with an average age of 9.83 years old.Vision loss was the chief complaint in the 18 cases,with 17 cases complained of binocular vision loss,1 case complained of monocular vision loss and 3 cases complained of diplopia.The precipitating factors could be found in all the cases:2 cases had tense relationship with their parents,4 cases had been punished by teachers,3 cases had a history of trauma,and 9 cases had a birth of newbore in family (2 cases had a fever history,1 case had a trauma history).The subjective visual acuity was 0.15-0.5,with an average of 0.30.The peak value of P100 wave in P-VEP examination was slightly delayed in 6 patients with concentric contraction of visual field.No abnormal results were found in other opthalmology examinations.Among the 6 patients who were previously misdiagnosed as "optic neuritis",4 cases had a history of trauma,2 cases had a newbore and fever history.Among the 18 patients,3 cases were hospitalized for psychological suggestions and neurotherapies,while the rest cases were treated with psychological counseling and suggestions in outpatient clinic.All patients' visual acuity improved to normal.There was no abnormal visual acuity after 1 month of follow-up. Conclusion Hysterical amblyopia in children has potential psychological precipitating factors.In these patients,the subjective and objective ophthalmic examinations results are separated,and the patients with trauma or fever symptoms are easily to be misdiagnosed.

     

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