Convergence paralysis is distinct from convergence insufficiency and usually secondary to an intracranial lesion, most commonly in association with dorsal midbrain syndrome (see BCSC Section 5, Neuro-Ophthalmology). It is characterized by normal adduction and accommodation, with exotropia and diplopia present at attempted near fixation only. Apparent convergence paralysis due to malingering or lack of effort can be distinguished from true convergence paralysis by the absence of pupillary constriction with attempted near fixation.
Figure 9-2 Dissociated strabismus complex. A, When the patient fixates with the left eye, a prominent vertical deviation is observed in the right eye. B, However, when the patient fixates with the right eye, a prominent horizontal deviation is noted in the left eye.
(Reproduced from Wilson ME. Exotropia. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 1995, module 11.)
Treatment of convergence paralysis is difficult and often limited to use of base-in prisms at near to alleviate the diplopia. Plus lenses may be required if accommodation is limited. Monocular occlusion is indicated if diplopia cannot be otherwise treated.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.