Convergence Insufficiency Differential Diagnoses

Updated: Jul 25, 2018
  • Author: Eric R Eggenberger, DO, MS, FAAN; Chief Editor: Hampton Roy, Sr, MD  more...
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DDx

Diagnostic Considerations

In patients with an otherwise full range of eye movements but acute complete loss of vergence to near targets, convergence paralysis may be a more fitting term. In these patients, it is important to ensure adequate effort by observing pupillary constriction. This presentation is more concerning for central neurologic lesions than typical convergence insufficiency. [22, 23] Similarly, associated neurologic or ocular motor features may broaden the differential diagnoses.

Uncorrected high hypermetropia or myopia is among the differential diagnoses.

Patients with combined convergence and accommodative insufficiency are usually more symptomatic than those with convergence insufficiency alone. However, symptoms alone are not sufficient to distinguish between these two entities, and an appropriate exam is critical. Anticholinergic drugs, closed head trauma, [24] and viral encephalopathies have been reported in association with this disorder. In addition to treating the convergence weakness, plus lenses should be prescribed to these patients for reading.

Differential Diagnoses