Dr Simon Barnard
PhD BSc FCOptom FAAO DCLP DipClinOptom

Department of Optometry & Visual Science
City University
London, UK

3rd Year Lecture


This lecture is based upon:- Chapter 20: Psychosomatic visual anomalies, Pediatric Eye Care, Eds.Barnard & Edgar (1996), Blackwell Science, Oxford

For full details of references, see Barnard & Edgar (1996)


Outline of lecture



What are psychosomatic anomalies?


Physical conditions in which emotional factors play an important part

From psychosomatic = "psyche" + "soma"

Organic disorders


but can the patientís emotional state affect recovery ?

Psychosomatic disorders

Psychopathology and physiology are so closely associated that both components actively and concurrently contribute to the natural course of the disorder.



Aetiologies of VCR

Cause &/or author


Conversion hysteria (Freud 1910)

Oedipal genital conflicts

Anxiety, depression, psychoneurosis, hysteria (Rada et al 1969)


Neurosis (Van Balen & Slijper, 1969)

Neurotic conflicts between hostility to parents and desire not to lose their love

Stress (Mantyjarvi, 1981)

Stress around time of puberty

"Complex family problems" (Leaverton et al, 1977)

11 year - oldís conflicts around father and stepfather

Anxiety (Lincoff & Ennis 1956)


10 year-oldís feelings of rejection and inadequacy re: family and friends

Yasuna, 1963


Pattern of home and school adjustment difficulties (26 children)

Barnard, 1989

Sexual abuse

Wolpe (1953)

Toilet training and feeding regime

Wynick, Hobson and Jones (1997)


School difficulties, loss of a significant figure, over involvement of mother, adjustment difficulties, obsessional personality traits in adolescence


"Synonyms" found in the literature


Psychogenic visual disturbance

Freud, 1910

Hysterical blindness

Wolff and Lachmann, 1938

Hysterical amblyopia

Yasuna, 1963


Rada et al, 1969

Ocular conversion reaction

Krill and Newell, 1968

Psychogenic amblyopia

Van Balen et al, 1978

Amblyopic School Girl Syndrome

Mantyjarvi, 1981





Mantyjarvi 1.4 cases/1000 children (7-18 years)/year.


Eames (1947) 9% of 193 unselected children exhibited tubular fields. A third of these children had hysterical personalities.

Personal experience (Dr Barnard) is that VCR is not uncommon in a busy paediatric practice and may be more prevalent amongst large orthodox religious families.

Age & sex

Youngest in literature (Wolpe, 1953) is a 2-year old with amaurosis.

Modal peaks (all literature) occur at 10-11 and 13-14 year-old age groups.

4 times more common in females why ?


Signs & symptoms (from the literature)



VCR versus Organic disease

VCR versus Malingering


Raising the index of suspicion



Management of VCR by the eye care practitioner



Authorís e-mail address: