Anomalies of
convergence-
Atiology & Treatment
Convergence
• It is a disconjugate movement in the eyes in which
eye moves inwards.So that the line of sight will
intersect infront of eyes.Also known as synchronous
adduction of each eye.Helps to maintain bifoveal
single vision at any fixation distance.
Anomalies of convergence
1.convergence insufficiency:
• Inability to obtain or maintain adequate binocular
convergence.
• Most common cause of ocular asthenopic symptoms.
• Etiology :
• A) Idiopathic
• In many cases exact etiology is not known
• Maybe associated with wide IPD,general
debilit,psychological inability,over work
worry,delayed functional development.
• B) Refractive
• Associated with uncorrected high hyperopia and
myopia.
• High hyperopes (>5D) usually make no effort to
accommodate and there is difficult accommodative
convergence.
• Myopia may not used accommodation and lack
accommodative convergence.
• C) presbyopia
• D) Muscular imbalance
• Exophoria,vertical muscle imbalance.
~Consecutive convergence insufficiency:
May occur following either resection of medial recti
or resection of lateral rectus muscle.
Clinical feature:
• Clinical problem in patient who does intense near
works:
• -children with increased school works
• -computer users
• -precision workers
• Symptoms can be divided into as follows:
• 1) symptoms due to muscular fatigue
• Eye strain and sensation of tension around the globe.
• Headache and pain in the eye after intense near work.
• Difficulty in changing focus from distance to near
objects.
• Itching,burning,soreness of eyes.
• 2) symptoms due to failure to maintain BSV
• Blurred vision.
• Intermittent crossed diplopia for near under the
condition of fatigue.
• Crowding of words while reading.
• Treatment
• 1)optical
• Proper refractive error correction
• In adults older than 40,proper presbyopic correction
should be given
• 2)orthoptic treatment
• Advancement excersice (pencil push up excersice)
• Jump convergence excersice
• Convergence excersice with prisms (bO)
• Convergence excersice with synoptophore
• Exercise using convergence card
• Convergence exercise with diploscope
• Physiological diplopia exercise using stereogram
•
• 3) surgical treatment
• When it is associated with large exophoria at near
• Medial muscle resection can be performed in one or
both eyes
• 2. Convergence paralysis
• Total lack of convergence
• Etiology
• Occurs according to some organic disease of the
brain
• The organic brain lesion are ;
• -head injury,encephalitis
• -disseminated sclerosis
• -Tabes dorsalis
• -tumours
• Clinical features:
• Convergence is completely absent
• Exotropia/crossed diplopia occurs on attempted near
fixation
• Accommodation is usually normal/reduced
• ~parinaud's syndrome
• Convergence paralysis associated with vertical gaze
paralysis
Treatment
• Prescribe BI prism
• Plus lens with base in prisms
• Occlusion of one eye at near
• Eye muscle surgery is contraindicate
• 3. Convergence spasm
• Characterized by intermittent episodes of maximal
convergence usually associated with spasm of accommodation
• Etiology
• Functional cause :
• In patient with hysteria/necrosis
• In most of the cases causes is functional
• Organic causes :
• Rarely associated organic lesions ;
• -head trauma
• -encephalitis
• -pituitary adenomas
• -Tabes etc...
• Clinical features
• Extreme convergence
• Intermittent diplopia
• Induced myopia
• Blurring of vision
• Miosis
• Condition is episodic
• Management
• Neurological evaluation
• Monocular occlusion
• psychiatric work up
• Prolonged atropinization with plus lens for near
Thank
you
