title: Unusual Presentation of Spasm of Near Reflex Mimicking Large-Angle Acute Acquired Comitant Esotropia.
abstract: We report the case of an 11-year-old boy who presented with sudden esotropia, binocular diplopia, and blurred vision. The patient was neurologically normal. He had a large, constant, comitant, alternating esotropia associated with minimal accommodative spasm. Ocular motility and pupillary reactions were normal. He was diagnosed to have spasm of the near reflex presenting as acute onset of esotropia. The esotropia was persistent despite treatment and eventually resolved with prolonged cycloplegic therapy. This unusual case illustrates that spasm of the near reflex can have unique and variable presentations. Spasm of the near reflex needs to be considered in the differential diagnosis of every case of acute, acquired, comitant esotropia. This is the first case of spasm of the near reflex where persistent esotropia is reported in the absence of any neurological disorder.
authors.affiliation: Department of Paediatric Ophthalmology, Strabismus and Neuroophthalmology, Venu Eye Institute and Research Centre , Sheikh Sarai , New Delhi, India and.
authors.forename: Varshini
authors.initials: V
authors.lastname: Shanker
authors.affiliation: Department of Oculoplasty and Orbit, Venu Eye Institute and Research Centre , Sheikh Sarai , New Delhi, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Nigam
keywords: Acute onset comitant esotropia; atropine; spasm of near reflex