Ocular Malingering

Abstract

Malingering can take a positive or negative form. Negative malingering occurs when an individual tries to hide the signs or symptoms of a naturally occurring disease that is present. Most of the discussion in the literature concerns positive malingering, whereby an individual attempts to deceive society with signs and symptoms of an illness that he does not actually have. Whether the conscious deception is due to a factitious disorder, where the individual is creating the illusion of illness in a desire to experience the sick role, or malingering, where the individual is creating the illusion of disease to gain a benefit or avoid a duty, there are different forms the deception can take. The individual can fabricate symptoms he has not actually experienced (complaint of pain in the eye); imitate signs of a disease (severe squint in reaction to any light); exaggerate symptoms of a mild disease, claiming a worse disability than actually exist (claim total blindness in an eye after a mild corneal abrasion); obfuscate the circumstances of an injury or illness, claiming it occurred from a different mechanism or situation (claim foreign body in the eye while at work when it occurred mowing the lawn); and lastly, actually create real disease by self-inflicted injury, mechanical or chemical (rub dirt or contaminated fluid in eye to cause conjunctivitis). Risk factors that raise an index of suspicion for malingering are a medicolegal context of presentation, a marked discrepancy between examination findings and the claimed disability, and a lack of cooperation during the examination. Examiners are advised to remain professional and objective due to the potential hostility a confrontation with a malingering patient can engender.