Ocular Münchausen Syndrome In A 21-Year Old Female

To report an interesting case of ocular Münchausen syndrome in a young female patient and raise awareness to the ophthalmologists of this disease entity.

A 21-year-old female patient, accompanied by her spouse ,visited our emergency department complaining of pain, blurry vision, foreign body sensation and photophobia in her right eye. The patient reported that she was visiting various doctors for the past two months , but her condition was getting worse. She was not a contact lens user and had no prior history of trauma .  

Slit lamp examination in her right eye revealed marked circumcorneal injection and the presence of a central corneal stromal infiltrate with an overlying epithelial defect , localized corneal thinning and iris tamponade, covered with epithelium. The Seidel sign was negative and the anterior chamber had a good depth, with fibrinous material and hypopyon. Posterior synechiae were also present while iris details were not visible.  The B – scan of her right eye was normal. Best corrected visual acuity (BCVA) was hand movement in her right eye and 0,9 in the left, and the intraocular pressure was normal in both eyes. The clinical findings of the fellow eye were unremarkable.

However, we noticed that her fingers had scars and her nail hygiene was poor. We took a more detailed history, and she admitted that she was self injuring her hands, and her eye with her fingers all the time, with no particular reason. We consulted her that she needs hospital admission for her eye condition and psychiatric assessment. She denied the hospitalization and insisted that she would be consistent with her treatment and find her own psychiatrist. We took sample for corneal culture and PCR for fungi and herpes viruses and gave her instructions for topical therapy with wide spectrum antibiotics and antifungal eye drops. We consulted our psychiatrists and they diagnosed her with Münchausen syndrome. 

We lost her in the follow-up, but after a telephone communication with her spouse, he reported that she had stopped self injuring her eye and she was using her eye drops. Ophthalmologists should be aware of Münchausen Syndrome, especially in cases when ocular abnormalities cannot be explained otherwise. An empathetic and supportive approach is therefore required and these patients should be referred to a psychiatrist.