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Munchausen syndrome by proxy should be considered for unexplainable medical conditions

SAN FRANCISCO--Ophthalmologists and other medical professionals should consider Munchausen syndrome by proxy if a child has unusual ocular abnormalities or other medical conditions that cannot be explained through medical evaluation. This is the recommendation of the authors of a case report appearing in Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association.

In this particular case, Munchausen syndrome by proxy is a form of child abuse. The symptoms of a disease are fabricated or induced by the caregiver, usually the mother of the patient, leading to unnecessary medical examinations and treatments.

In this interventional case report, an infant was brought to an emergency center at a large hospital several times, and eventually hospitalized for the treatment of various medical problems, including recurrent ocular symptoms. However, when the causes and recurrence of the conditions could not be explained, medical personnel began to suspect Munchausen syndrome by proxy. Child Protective Services was contacted and the patient's mother later admitted to inflicting the injuries.

"One of the problems with this form of abuse is the perpetrator appears to be very cooperative and helpful," said Jane Kivlin, MD, Academy spokesperson and professor of pediatric ophthalmology at the Children's Hospital of Wisconsin in Milwaukee. "Medical personnel are less likely to suspect them." According to the study, the symptoms, signs and laboratory findings of Munchausen syndrome by proxy span a wide spectrum. The most common symptoms include bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever and rash. Although rare, cases with ocular involvement have been reported.

One of the report's authors, David Coats, MD, associate professor of ophthalmology at the Baylor College of Medicine's Cullen Eye Institute, Houston, said, "A diagnosis of Munchausen syndrome by proxy should be
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Contact: Media Relations
media@aao.org
415-561-8534
American Academy of Ophthalmology
8-Aug-2003


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