ABSTRACT
AIM: The aim of the study was to assess the value of the ophthalmological independent medical examination (IME) for detecting malingering, exaggerated or feigned symptoms, and incorrect causal relationship. DESIGN: Retrospective observational cohort study. METHODS: Consecutive examinees (n = 344) who underwent an IME by a single examiner between 1998 and 2005 in the setting of an ophthalmological group practice were included in the study. Diagnoses were made to at least a degree of medical certainty. Main outcome measures were frequency of exaggerated, feigned and non-causally related pathology and symptoms. RESULTS: In 172 claimants (50%), the symptoms and pathology claimed were fully substantiated. The other 172 claimants were found to have either exaggerated or totally feigned symptoms and/or symptoms and pathology misattributed (non-causally related to the claimed accident or incident). The most frequent feigned/exaggerated symptoms were visual loss (74%), ocular pain/discomfort (28%), visual field loss (19%), headaches (17%) and photophobia (13%). Visual field loss and the symptoms of ocular discomfort, headaches, dizziness and epiphora were more frequent in the feigning group (p<0.01). In contrast, complaints of swelling and deformity were more frequent (p = 0.001) among the examinees with real pathology. Review of the medical records provided helpful information in 163/172 cases in the feigning group. CONCLUSIONS: An ophthalmological IME is useful for detecting malingering, as well as symptoms and pathology not causally related to a claimed accident or injury or actually pre-existent to a claimed date. The advantages of an IME compared with relying on treating-doctor records, clues for diagnosing feigning and incorrect causal relationship, and guidelines for performing an ophthalmological IME are discussed.
Subject(s)
Eye Diseases/diagnosis , Malingering/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Compensation and Redress , Cooperative Behavior , Diagnostic Techniques, Ophthalmological , Disability Evaluation , Expert Testimony , Eye Diseases/etiology , Eye Diseases/psychology , Female , Humans , Male , Medical Records , Middle Aged , Retrospective Studies , Vision Disorders/diagnosis , Vision Disorders/etiology , Vision Disorders/psychology , Workers' Compensation , Young AdultABSTRACT
BACKGROUND: Mooren's ulcer is a peripheral corneal ulceration of presumed autoimmune aetiology. Its clinical course and eventual prognosis is variable and usually these ulcers respond poorly to conventional therapy. HISTORY AND SIGNS: A 67-year-old male was referred to our hospital for a painful, red and tearing left eye after receiving debris. Slit-lamp examination revealed a 3.2 x 2.1 mm peripheral corneal ulcer, a diffuse thinning of the lateral limbus (between 3 o'clock and 5 o'clock) and some endothelial precipitates. The conjunctiva was severely congested. In the anterior chamber, cells (++) and fibrin were found. THERAPY AND OUTCOME: We introduced an antibiotic, corticosteroid and cyclosporin therapy to treat the marginal corneal deficit caused by Mooren's ulcer. The patient did not respond to the initial treatment, but re-epithelialisation occurred and the corneal deficit improved after the introduction of autologous serum eye drops. CONCLUSION: Autologous serum seems to be an effective supplementary therapy in Mooren's ulcer.
