2020–2021 BCSC Basic and Clinical Science Course™
6 Pediatric Ophthalmology and Strabismus
Part I: Strabismus
Chapter 9: Exodeviations
Other Forms of Exotropia
Convergence Paralysis
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.
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.