title: [Dissociated near reflex and accommodative convergence excess].
abstract: We report on an 8-year-old boy whose near reflex could be elicited exclusively when the left eye was fixing (LF) but not when the right eye was fixing (RF). With RE +1.25/-1.25/169 degrees and LE +1.0/-0.75/24 degrees, the visual acuity was 1.0 OU at 5 m and RE 0.5, LE 1.0 at 0.3 m improving to 1.0 OU by a near addition of 3.0 D. Stereopsis was 100 degrees (Titmus test). The prism and cover test revealed an esophoria of 4 degrees at 5 m. At 3 m there was an esophoria of 6 degrees (RF) and an esotropia of 28 degrees (LF), compensating to an esophoria of 3 degrees (RF/LF) with a near addition of 3.0 D. Accommodation and the pupillary near reaction (OU) were hardly elicitable during RF. During LF, retinoscopy revealed an accommodation of 8 D (OU) and the pupils constricted normally. Correction by bifocal glasses yielded orthotropia with random dot stereopsis at near.
authors.affiliation: Augenklinik für Schielbehandlung und Neuroophthalmologie, Justus-Liebig-Universität, Giessen. michael.h.graef@augen.med.uni-giessen.de
authors.forename: M
authors.initials: M
authors.lastname: Gräf
authors.forename: R
authors.initials: R
authors.lastname: Becker
authors.forename: S
authors.initials: S
authors.lastname: Kloss
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D002648:Child; D003290:Convergence, Ocular / Q000502:physiology; D004948:Esotropia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005139:Eyeglasses; D005403:Fixation, Ocular / Q000502:physiology; D006801:Humans; D008297:Male; D009216:Myopia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D009887:Ophthalmoscopy; D012018:Reflex / Q000502:physiology; D012029:Refraction, Ocular / Q000502:physiology; D014787:Vision Tests; D014792:Visual Acuity / Q000502:physiology