Nonstrabismic binocular vision abnormalities_ excessive collection

Nonstrabismic binocular vision abnormalities: excessive collection

Convergence excess (CE) is also a relatively common binocular vision dysfunction, patients can have obvious symptoms, often after prolonged reading or computer work, some patients may also be accompanied by accommodative dysfunction, for these patients can be significantly improved after wearing positive lenses or visual therapy. Patients may present with seclusion in near vision, orthotopic or low to moderate esotropia in distal vision, decreased negative fusion aggregation, and high AC/A values. Hyperconvergence is also one of the more common non-strabismic binocular abnormalities. 1. The symptoms of symptomatic patients are often related to long-term close work, computer use, etc., and the common symptoms are as follows. 1. Double vision. 2. Eye tension and fatigue. 3. Pulling around the eyes. 4. Pain in the forehead above the orbit at night. 5. There is a sense of overfocus. 6. Blurred vision (can occur in both farsightedness and nearsightedness). 7. You want to avoid working in close proximity as much as possible. 8. Likes to keep books close to each other when reading. 9. Wish you could close your eyes. 10. Head tilt occurs after visual fatigue. 2. Signs: 1. The amplitude of the internal oblique is often related to symptoms and signs to a certain extent. 2. The degree of implicit oblique is greater than that of farsightedness. The 3.AC/A value is high (generally greater than 5/1). 4. The divergence (BI) range of the close-range determination is small, and the collection (BO) range is large. 5. Convergence near point assay can reach the tip of the nose directly. 6. Reduced flexibility of adjustment, especially when negative lenses are placed in front of the eyes, it is difficult to eliminate blur images. 7. High negative relativity regulation (NRA), low positive relativity regulation (PRA) (under normal circumstances, NRA is +2.50, PRA is -3.50), which is more common in people with strong ensemble, but other binocular vision abnormalities must be excluded. 8. Accommodative dysfunction, patients may have a series of manifestations, such as abnormal flexibility and amplitude of monocular accommodation. 3. Diagnosis 1.Inquire about the patient's age, reading habits, whether the symptoms are related to these functional causes, severity, triggers when symptoms occur, accompanying symptoms, alleviating factors, general conditions, and medication. 2. General ocular examination and refractive examination If the patient has uncorrected refractive error, refractive correction should be performed first, and then binocular vision function test should be performed on the basis of refractive correction. 3. Ciliary muscle palsy dilated pupil refraction If there is latent hyperopia, or the refractive power is found to fluctuate and be unstable during refractive examination, cycloplegic dilated pupil refraction is required, and the appearance of seclusion during near vision may often indicate latent hyperopia. 4. It is necessary to understand the binocular vision during distance vision The determination of the degree of heterophoria and the reserve convergence range during distance vision to rule out insufficient separation and internal scabies. 5. Measurement of near binocular vision function This is the main basis for diagnosis, including occlusion test, near horizontal heterogeneous assay measurement, convergence proxima measurement, AC/A, fusion convergence and dispersion range, adjustment flexibility, adjustment amplitude measurement, etc. 6. Stereopsis measurement Stereopsis function measurement is also necessary, and the decline or absence of stereopsis often indicates the possibility of strabismus. 7. Pupillometry excludes miosis associated with conglomerated spasm. 8. Visual field test This test is required if hysteria is suspected. 9. Others: Diagnosis can be made based on the medical history and examination results that meet the above collective strong signs. 4. Differential diagnosis 1. Incorrect refractive correction If no refractive correction or incorrect correction (such as farsightedness or myopia overcorrection) will also occur, similar manifestations of excessive aggregation will occur, and cycloplegic refraction must be performed. 2. Basic (simplex) seclusion The degree of distance and proximity is the same, and the main point of treatment is to eliminate the seclusion through visual training or lenses. 3. Insufficient separation The patient presents with secretropia and/or internal oblique greater than the degree of near vision, and occasionally diplopia occurs when the distance is far, if it is suspected to be caused by lateral rectus paralysis, neurological examination must be done. 4. Drug factors Some drugs should not cause excessive collection and regulation of spasticity, physostigmine, pilocarpine, etc., so it is necessary to carefully ask for a medical history to understand the patient's drug history, dosage and the relationship between drugs and symptoms. 5. Cluster spasm Sudden onset, both eyes are obviously inverted, and fixed at one point. It has an intermittent onset, and can return to normal during intervals, and lateral movement in the same direction may be normal. At the onset of the disease, there is diplopia in near and far sight, accompanied by miosis, accommodative spasm, visual impairment, etc. The most common cause of cluster spasms is neurosis, which can also be seen after encephalitis or trauma. 5. Treatment and treatment: 1. Correction of refractive error If the patient has farsightedness, correction of refractive error can eliminate the internal oblique and relieve the symptoms. 2. Additional reading lenses The use of positive reading lenses may be an effective way to eliminate the symptoms of such patients. If the patient does not have farsightedness, the additional reading glasses can be +0. 75 to +1. 25 D, if there is original farsightedness, the power can be increased.。