Case Series
Eye (2008) 22, 316–317; doi:10.1038/sj.eye.6703009; published online 19 October 2007
Blurred vision due to psychosocial difficulties: a case series
E M Middleton1, M D A Sinason2 and Z Davids3
- 1University College London Hospitals (UCLH NHS Trust), London, UK
- 2Forest House Psychotherapy Clinic, Thorpe Coombe Hospital (NELMHT NHS Trust), London, UK
- 3University College London Hospitals (UCLH NHS Trust), London, UK
Correspondence: EM Middleton, PO Box 31645, London W11 2UZ, UK. Tel/Fax: +44 0207 221 0621; E-mail: lizmiddleton@btinternet.com
Received 27 June 2007; Accepted 10 September 2007; Published online 19 October 2007.
Abstract
Purpose
The association between psychological difficulties and accommodative insufficiency in children and young adults has been previously reported. The authors give their experiences with such cases and address the research and service developments required to deal with these problems.
Methods
When no other organic pathology was found in full ophthalmological assessment, and where insufficient improvement in accommodation was found in orthoptic treatment, the patients were referred to liaison psychiatry or to adult or child psychotherapy services for assessment.
Results and conclusions
Some cases of accommodative insufficiency referred for ophthalmological assessment were found to have psychosocial difficulties, which played a role in the development of the complaint. For patients and clinicians, it is hard to understand how there can be a psychosomatic translation between personal difficulties and ocular symptoms. The authors use the concept of alexithymia to recognise that some people cannot describe their emotions in words and can only express them physically. The joint management of these cases by both psychiatry and ophthalmology has been valued by the patients.
Keywords:
accommodative insufficiency, alexithymia, liaison psychiatry, psychological, psychosocial, psychotherapy
