1

Article

l

*Graham B. Erickson, ODJohn R. Griffin, OD, MSEd

Janis I. Kurihara, OD

Streff SyndromeA Literature Review

This article presents an historical perspective of the characteristics ofStreff syndrome. A clinical approach to differentiate this syndrome fromhysterical amblyopia and malingering is profiled, but there is some over-lapping of characteristics of these conditions that may obfuscate differ-ential diagnosis. Management considerations for each of these are dis-cussed. Key Words: hysterical amblyopia, malingering, Streffsyndrome,vision therapy.

agnostic approach to delineating malingering,hysterical amblyopia, and Streff syndrome isoutlined. Management considerations for eachof these conditions are discussed.

INTRODUCTION

HISTORICAL REVIEW

An editorial on the Streff syndrome dis-cussed a "gray area concerning malingering,Streff Syndrome and hysterical amblyopia."lThis prompted us to carefully review the lit-erature, and we found ambiguity in the defi-nition and clinical findings constituting thediagnosis of the Streff syndrome. Further-more, we could find no agreement as to thename of this syndrome, eg, juvenile bilateralfunctional amblyopia, Streff syndrome, non-malingering syndrome, or early adaptive syn-drome. However ambiguous the definitionmay be, there is consensus among many be-havioral optometrists that this syndrome is aclinical entity, separate from either hystericalamblyopia or malingering.

The purpose of this article is to present anhistorical perspective of the diagnostic charac-teristics of Streff syndrome. A differential di-

Correspondence regarding this article should beaddressed to Graham B. Erickson, OD, SouthernCalifornia College of Optometry ,2575 Yorba LindaBoulevard, Fullerton, CA 92631-1699.

64

Visual disturbances of psychogenic originwere reported by the ancient Greeks.2 Theword "hysteria" comes from the Greek wordhysterikos, which means "suffering in thewomb."3 It was not until the late 19th centurythat Charcot first demonstrated that hysteriaoccurred in males as well as females.2 Babin-ski theorized that visual manifestations ofhysteria were "caused by suggestion and curedby persuasion."4 Freud, in 1910, postulatedthat visual disturbances were a physical man-ifestation of subconscious emotional turmoil ofsexual origin (primarily involving the oedipalcomplex), a conversion reaction.5

Descriptions of the visual characteristicsof hysterical amblyopia and malingering ap-peared periodically in the literature in subse-quent years.6-13 There was much interest inthe nature of hysterical amblyopia and malin-

Journal of Optometric Vision Development