[Dissociated near reflex and accommodative convergence excess]
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Updated: Aug 20, 2026

Quantification of Oculomotor Responses and Accommodation Through Instrumentation and Analysis Toolboxes
Published on: March 3, 2023
1Augenklinik für Schielbehandlung und Neuroophthalmologie, Justus-Liebig-Universität, Giessen. michael.h.graef@augen.med.uni-giessen.de
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.
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