title: Blurred vision due to psychosocial difficulties: a case series.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: University College London Hospitals (UCLH NHS Trust), London, UK. lizmiddleton@btinternet.com
authors.forename: E M
authors.initials: EM
authors.lastname: Middleton
authors.forename: M D A
authors.initials: MD
authors.lastname: Sinason
authors.forename: Z
authors.initials: Z
authors.lastname: Davids
mesh_terms: D000065:Accommodation, Ocular; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D010348:Patient Care Team; D011602:Psychophysiologic Disorders / Q000523:psychology* / Q000628:therapy; D011613:Psychotherapy; D012919:Social Behavior; D014786:Vision Disorders / Q000523:psychology* / Q000628:therapy