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A case of dissociated spasm of the near reflex
Gräf M., Schwerdtfeger G.
Department of Ophthalmology, University of Gießen
Purpose: A 21-year-old woman was referred to our department because of an intermittent esotropia. In childhood she had received occlusion therapy. For severals years she suffered from circulatory disturbance classified to be psychogenic. She received chiropractic treatment.
Method: Biomicroscopy, refractometry (cyclopentolate-HCl 1%), assessment of visual acuity, accommodative range, and ocular motility, Bagolini striated glasses-test, Titmus- and Lang-stereotest, unilateral and alternate prism and cover test, pulse control, ECG, hematometry, cranial MRI.
Results: The visual acuity was 1.0 OU. The refraction was +0.25 D sph comb -0.25 cyl X 35° OD and +1.0 D sph comb -0.5 cyl X 155° OS. Stereopsis was lacking. The accommodative range was 10 D. The cover test showed orthotropia. When the left eye was covered, there was an esophoria of +4° (5 m) and +8° (.3 m) with comitant squint angles in the secondary gaze positions. Immediately after covering the right eye (but not when both eyes together were being occluded) a spasm of the near reflex (convergence of about 20°, miosis, myopization) began, together with a feeling of pressure behind the right eye and severe unwellness. The pulse rate increased from 78/s to 108/s. About 2 minutes after uncovering, the spasm relaxed. These findings were reproducible on different days without an exception. The remaining findings were normal. The patient accepted bifocals as being comfortable, but the spasms o
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