Hysterical blindness, now referred to as conversion disorder, is a sudden loss of vision that is not caused by any physical damage to the eyes. Diagnosis requires ruling out other causes of vision loss, and treatment focuses on addressing underlying psychological distress.
Hysterical blindness is a condition in which patients lose the ability to see. The term “hysterical blindness” has fallen out of use in recent years and this condition is now officially referred to as conversion disorder. Affected patients believe they have an inability to see, when in fact their vision is physiologically preserved. Diagnosing the disease requires ruling out other causes of vision loss. Treatment is typically based on addressing any underlying psychological distress.
The symptoms of this condition come on suddenly. Patients describe loss of vision in a portion of one eye, all of one eye, or both eyes. Sometimes the loss of the ability to see can be accompanied by other deficits, such as the inability to move half of the body. Often patients express a lack of concern about their ability to see.
Making the diagnosis of hysterical blindness typically requires an ability to fully understand the patient’s emotional states and recent life events, and also requires performing a nuanced physical examination. Often the symptoms are triggered by emotional stress. Although patients report an inability to see, there are actually no neurological deficits. The pupils of their eyes are capable of narrowing in response to light or when focusing on nearby objects. Doctors or other health care professionals may notice that patients blink if an object is thrown at their faces and may squint when asked to look at a distant object; in some cases it may be observed that patients read or watch television when they think they are not being watched.
Typically, this condition is thought to be a diagnosis of exclusion. In other words, other more serious medical conditions should be ruled out before a patient is assumed to have this condition. Patients who have suffered damage to the parietal lobes of the brain may have similar symptoms. A condition called multiple sclerosis can cause short-term neurological deficits and is another diagnosis that should be considered before diagnosing hysterical blindness.
Treatment of hysterical blindness focuses on relieving any underlying psychological stress. Patients might benefit from psychotherapy, in which they talk to a trained therapist about their thoughts and experiences. Medications may be used to treat coexisting depression or anxiety. Some psychiatrists and psychologists have also used hypnotherapy as an approach to regaining patients’ confidence in their ability to see, although the use of this technique is not well demonstrated or fully accepted.
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