# Streff-Like Syndrome in an Adult: A Case Report

## TL;DR

A middle-aged woman with depression developed Streff-like syndrome after stress, and her symptoms improved with interdisciplinary care.

## Contribution

This case report highlights Streff-like syndrome in an adult with depression and demonstrates successful interdisciplinary treatment.

## Key findings

- The patient showed visual symptoms consistent with Streff-like syndrome, including reduced near vision and constricted visual fields.
- Symptoms improved with a +1.00 lens and collaborative care involving psychiatry, neurology, and ophthalmology.
- At five months, the patient's visual symptoms resolved completely, emphasizing the role of stress and mental health in such cases.

## Abstract

Streff syndrome is a non-malingering visual disturbance commonly affecting near and color vision, which is prevalent in the younger population. This case report presents Streff-like syndrome in a middle-aged woman. A 47-year-old woman with underlying major depressive disorder presented with bilateral reduced vision and a constricted visual field for one week. These symptoms were accompanied by additional neurological complaints of headache, weakness, and numbness triggered after a stressful event that affected her work performance. Examinations revealed reduced vision more toward near, diminished red saturation, color vision deficiencies, and bilateral tubular visual fields. Notably, the relative afferent pupillary defect was negative, with both anterior and posterior segments normal. Neuroimaging and inflammatory workup results were within normal limits. An additional +1.00 lens improved her symptoms and visual acuities. Collaborative management involving psychiatry, neurology, and ophthalmology, including psychotherapy, led to significant symptom improvement. At the five-month follow-up, the patient experienced a complete resolution of her visual symptoms. Although Streff syndrome is a primary visual problem, additional psychogenic factors may add to variable cases. This case underscores the importance of recognizing stress-induced psychogenic manifestation, particularly in patients with underlying mental health conditions, and emphasizes an interdisciplinary management approach.