VERGENCE ABNORMALITIES

Question 1

Convergence insufficiency - in whom

Answer 1

school-age children, young adults

Question 2

Convergence insufficiency - signs

Answer 2

exophoria at near + poor near-fusional convergence amplitudes, low AC/A ratio, remote near point of convergence

Question 3

Convergence insufficiency - etiology

Answer 3

fatigue, illness, post-viral, parasympatholytics, uveitis, Adie tonic pupil, postexanthematous encephalitis, traumatic, Idiopathic

Question 4

Normal near point of convergence

Answer 4

<8 cm

Question 5

Convergence insufficiency - treatment

Answer 5

slightly undercorrect hyperopia and fully correct myopia, near-point exercises (without or with base-out prisms), reading glasses with base-in prisms

Question 6

Accommodative stress (spasm of the near reflex) - in whom

Answer 6

teenagers under stress, after prolonged and intense periods of near work. all ages? mainly females

Question 7

Accommodative stress (spasm of the near reflex) - signs

Answer 7

esotropia?, cycloplegic refraction reveals less myopia (or more hyperopia). excess accommodation, excess convergence, miosis. abnormally close near point of focus, normal amplitude of accommodation

Question 8

Accommodative insufficiency (AI)

Answer 8

prepresbyopic - uncorrected low hyperopia or over-minused myopia. While reading, a 4-diopter base-in prism placed in front of the eye blurs the print in AI, but improves clarity in convergence insufficiency. Rarely, adolecents may develop transient paresis of accommodation, requiring reading glasses or bifocals. This idiopathic condition resolves in several years

Question 9

Convergence paralysis - signs

Answer 9

Acute onset of exotropia and diplopia on near fiction only. normal adduction and accommodation

Question 10

Convergence paralysis - what to do

Answer 10

neuroimaging to rule out an intracranial lesion. comitant supranuclear gaze disorder secondary to ischemic infarction, demyelination, or viral infection

Question 11

Convergence paralysis - cause

Answer 11

usually results from a lesion in the corpora quadrigemina or the third cranial nerve nucleus, and may be associated with Parinaud syndrome

Question 12

Near reflex insufficiency - definition

Answer 12

dual convergence and accommodation insufficiency. Mydriasis may be seen on attempted near fixation

Question 13

Near reflex insufficiency - causes

Answer 13

Complete paralysis in which no convergence or accommodation may be of functional origin, due to midbrain disease or after head trauma; recovery is possible

Question 14

Divergence insufficiency - cause

Answer 14

rare, neurological disease, such as intracranial space-occupying lesions, cerebrovascular accidents and head trauma

Question 15

Divergence insufficiency - signs

Answer 15

rare. Primarily a concomitant esodeviation with reduced or absent divergence fusional amplitudes

Question 16

Divergence insufficiency - treatment

Answer 16

prisms