Spasm of the Near Reflex
Spasm of the near reflex (also known as ciliary spasm or convergence spasm) is a spectrum of abnormalities of the near response. The etiology is generally thought to be functional, related to psychological factors such as stress and anxiety. In rare cases, it can be associated with organic disease. Patients present with varying combinations of excessive convergence, increased accommodation, and miosis. Patients may present with acute esotropia alternating with orthotropia. Substitution of a convergence movement for a gaze movement with horizontal versions is characteristic. Monocular abduction is normal despite marked limitation of abduction on version testing. Pseudomyopia may occur.
Treatment consists of cycloplegic agents such as atropine or homatropine, hyperopic correction, and bifocal glasses. Counseling to address underlying psychological issues may be helpful. If the spasm cannot be broken, botulinum toxin injection of the medial rectus muscles and strabismus surgery may be considered with caution.
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.