Abstract Non-organic visual loss is a frequent challenge in ophthalmic practice. In children most patients are prepubertal females. The most frequent manifestation in this age-group is a bilateral unexplained decrease of visual acuity. In adulthood patients often indicate a degree of visual loss after an accident or a disease - that could not be explained by the eye condition alone. Non-organic visual loss may be frustrating for both, patients and physicians. The aim of the present article is to sensitize ophthalmologists to this condition and to provide a diagnostic frame and strategy how to manage patients with such a diagnosis.