| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JY) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Transcript |
So today we're going to be talking about the Anton syndrome. The Anton syndrome is a very interesting syndrome. Normally, patients who are blind know they're blind and don't try to pretend like they're not blind. However, patients with Anton syndrome, usually from cortical visual impairment, but it doesn't have to be cortical visual impairment, usually from bilateral occipital infarction or some lesion that's causing them to be cortically blind. They will have decreased visions, for example they're hand motions vision in both eyes. Obviously, the rest if the exams are going to be normal on the ocular side: the pupils, the slit lamp, the pressure, the motility, and the fundus exam are all going to be normal. The field shows juxtaposed homonymous hemianopsia, and that's why they're hand motions vision, or you can't even do a field limitation. So once you've established that they have some cortical level of vision loss, they have a normal structural eye examination and you've done an MRI scan and it shows the bilateral occipital lesion, the recognition of the Anton is important because the patients have cortical blindness plus, they deny that they're blind. And what's fascinating about the syndrome is that they will confabulate. They will just make up answers so if you ask them can you read, they'll say yes of course, but you give them the card, they'll make up some excuse of why they can't read it. They will claim that they can see that you're wearing a white coat, or a beautiful tie, or a beautiful dress, and beautiful hair. They will make up answers for their vision. It's not clear why patients with Anton syndrome have this lack of insight into their blindness; it's also not clear why they can confabulate, but it is a syndrome that you need to be aware of because the patient actually has no chief complaint. Their chief complaint is I can see, I don't know why you're here, I have nothing wrong with my vision, and that's going to throw you off. So, the Anton syndrome is typically a cortical visual impairment, do an MRI scan, the key feature recognizing that Anton's patients say they can see even though they can't see, they confabulate the vision answers, they have a normal structural eye exam but have decreased visual function. You should also know that it doesn't have to be cortical, it can really be any consequential visual loss. We call that the Anton syndrome. |
