obsolete convergence excess or spasm

Convergence Excess/Spasm: An Obsolete Condition

Convergence excess, also known as convergence spasm, was a condition characterized by an exaggerated inward movement of the eyes when attempting to focus on nearby objects. This ocular anomaly presented as an excessive convergence, adjusting their alignment to bring close-up objects into a unified and clear visual field.

Symptoms and Presentation

• Exaggerated inward movement of the eyes (convergence excess)
• Intermittent episodes of convergence, miosis (pupillary constriction), and accommodation
• Disconjugate gaze mimicking abducens palsy

Causes and Etiology

Convergence spasm was initially thought to be caused by organic lesions or neurological disorders. However, it was later found that the condition could also arise from non-organic causes such as hysteria or conversion disorder.

Clinical Features and Diagnosis

• Sustained convergence, miosis, accommodation
• Convergence spasm can be due to either organic lesions or functional disorders

Treatment and Management

There is no specific treatment mentioned for convergence excess/spasm in the provided context. However, it's worth noting that the condition was considered obsolete, suggesting that modern understanding and management of similar conditions have superseded this particular diagnosis.

References

• [1] Convergence spasm (CS) means intermittent episodes of convergence, miosis and accommodation with disconjugate gaze mimicking abducens palsy.
• [4] The triad of sustained convergence, miosis, accommodation characterizes convergence spasm or spasm of the near reflex.
• [9] Classically convergence spasm is nonorganic.

Note: The information provided above is based on the context and search results. However, it's essential to consult a medical professional for accurate diagnosis and treatment of any ocular condition.

Convergence excess, also known as accommodative convergence to near (AC/N) spasm, is a condition where the eyes have difficulty converging on a point, leading to symptoms such as:

• Double vision [11][12]
• Blurred vision [11][12][13]
• Eye strain [11][13]
• Headaches [3][4][6][9]
• Nausea and dizziness [3][4][6][9]

In some cases, convergence excess may be due to organic causes such as myasthenia gravis, multiple sclerosis (MS), or a viral infection. If you suspect that your symptoms are related to an underlying medical condition, it is essential to consult with an ophthalmologist or neurologist.

It's worth noting that convergence excess was once considered a distinct entity from other binocular vision disorders, but recent research suggests that it may be more closely related to convergence insufficiency. However, the exact relationship between these conditions remains unclear.

Symptoms of convergence excess can vary in severity and may include:

• Esophoria greater at distance than near [3][4][6][9]
• Low AC/A ratio [3][4][6][9]

If you are experiencing any of these symptoms, it is essential to consult with an eye care professional for proper diagnosis and treatment.

References: [1] Apr 13, 2020 — Ocular inflammation such as scleritis, iritis, and uveitis can cause uniocular accommodative spasm and esophoria. This suggests that slit lamp ... [3] Symptoms include: double vision, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs: esophoria greater at distance than near, low AC/A ... [4] Symptoms include: double vision, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs: esophoria greater at distance than near, low AC/A ... [6] Symptoms include: double vision, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs: esophoria greater at distance than near, low AC/A ... [9] Symptoms include: double vision, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs: esophoria greater at distance than near, low AC/A ...

Based on the provided context, it appears that there are several diagnostic tests that were used to evaluate convergence excess or spasm in the past. Here are some of the direct tests of accommodation and convergence that were mentioned:

• Cover test: This test was used to demonstrate an exophoria for near fixation with good recovery becoming esophoria on extreme effort to accommodate (Source: [5])
• Near point of convergence test: This test involves asking the patient to focus on a small object held at arm's length and is one common test used to evaluate convergence excess (Source: [13])

Additionally, other tests that were mentioned as being relevant to evaluating convergence excess or spasm include:

• Orthoptic exam: This exam was recommended to identify convergence excess or spasms (Source: [2])
• Assessment of extraocular movements: This assessment was also recommended to evaluate convergence excess or spasms (Source: [2])

It's worth noting that these tests may not be as commonly used today, and more modern diagnostic approaches may have replaced them. However, they were mentioned in the context as being relevant to evaluating convergence excess or spasm.

References:

• [1] Suggests that slit lamp evaluation is an important test in the differential diagnosis of convergence excess.
• [2] Recommends ocular examinations including assessment of extraocular movements and orthoptic exam to identify convergence excess or spasms.
• [5] Mentions cover test as a demonstration for near fixation with good recovery becoming esophoria on extreme effort to accommodate.
• [13] Mentions near point of convergence test as one common test used to evaluate convergence excess.

Treatment Options for Convergence Excess or Spasm

Convergence excess or spasm can be treated using various pharmacological and non-pharmacological methods.

• Cycloplegic Drugs: The most effective option is to use cycloplegic drugs to relax the ciliary muscle spasm. Atropine 1% has been shown to have a better result in treating accommodative excess cases [8]. Other typical cycloplegic eye drops used once daily include Cyclopentolate, Tropicamide, and Homatropine [9].
• Pharmacological Relaxation: Pharmacological relaxation of the accommodative spasm with strong cycloplegics such as atropine is commonly used for both diagnosis and management [6]. This treatment option has been reported to be effective in treating convergence excess cases.
• Other Treatment Options: In some cases, other treatment options may be considered, such as occlusion of the medial portion of spectacles or rare use of prism lens. However, these methods are not as commonly used as cycloplegic drugs.

References

[8] Aug 25, 2023 — Pharmacological: The most effective option is to use cycloplegic drugs to relax the ciliary muscle spasm. Atropine 1% show a better result ...

[9] Cyclopentolate, Atropine, Tropicamide, and Homatropine are the typical cycloplegic eye drops used once daily to treat spasm of accommodation by relaxing the ...