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

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.