Spasm of the Near Reflex: Clinical Appearance

Abstract

Dear Editor, An 18-year-old female patient was admitted to our clinic with sudden-onset horizontal binocular diplopia, marked headache on the left eyebrow, and limited abduction of the left eye that started one day ago. The patient noted that she had had similar symptoms that resolved spontaneously before, but that this time it was more severe. The patient had no history of febrile illness; trauma; regular medication use; neurologic, psychiatric or other systemic disease; and ocular surgery. A neurologic examination revealed intact visual acuity in both eyes and horizontal diplopia. In the primary position, there was left convergent strabismus (Figure 1). On light reflex examination, the left pupil was meiotic. Bilateral pathology was not observed in extraocular muscles (Figures 2A, 2B). The examination performed by the ophthalmology clinic revealed no pathology in the anterior and posterior segment of the eye, and the optic disc was normal. Visual field examination with visual achromatic perimetry was normal. No pathology was found in the remaining neurologic or ophthalmologic examinations. Cranial computed tomography (CT), CT angiography, and magnetic resonance imaging showed no pathology. Thyroid Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: