高齢者の心因性視覚障害11例

Psychogenic visual disturbance in eleven aged persons

　当院で心因性視覚障害と診断した60歳以上の11例21眼について，病態の特徴と診断の要点を検討した。視力は0.5以下が19眼（90％），0.1以下が10眼（48％）にあり，求心性視野狭窄が11眼（52％）にあった。年齢は61歳から85歳，平均69.8±7.9歳であった。軽度から中等度の器質的な眼または全身疾患があり，精神的に孤独かつ不安で，1人暮らしで孤立し，経済的に困窮している例が多く，これらが複合して心因性視覚障害が生じたと推定した。診断では，視覚障害に矛盾して瞳孔反応が良好であり，各検査項目が矛盾し，日常生活行動を観察することが有用であった。他覚的な眼症状が検査所見と一致しないときには，高齢者でも心因性視覚障害を疑うべきことと，特に瞳孔反応に注意する必要があると結論される。

We reviewed 21 eyes of 11 cases aged 60 years or over who were diagnosed as psychogenic vis-ual disturbance by us. The ages ranged from 61 to 85 years, average 69.8±7.9 years. The visual acuity was 0.5 or less in 19 eyes (90 %) and 0.1 or less in 10 eyes (48%). Concentric visual field constriction was present in 11 eyes (52%) . The majority of patients had light to moderate eye or systemic disorders. They were living alone and were mentally isolated and anxious. Many were economically strained. These factors, when com-bined, appeared to have contributed to psychogenic visual disturbance. Following features served as useful keys to diagnosis: normal pupillary reaction in spite of visual disturbance, incongruity among various clinical findings, and well-being in their daily life. The features show that psychogenic disturbance is a possibility in aged persons in the presence of incongruity among objective and laboratory findings. We advocate pupillary reaction as a useful key to the diagnosis.