Spasm of the near reflex in a patient with multiple sclerosis

A 33-year-old woman with a history of relapsing-remitting multiple sclerosis presented with complaints of episodic horizontal diplopia and blurred vision over the past two months. The patient gave a past history of similar episodes of diplopia that had occurred with previous clinical relapses of her multiple sclerosis. On eye movement examination, the patient exhibited intermittent spasms of convergence coupled with miosis. On upward gaze, the convergence and miosis became more marked. An auto-refraction revealed variable measurements in both eyes, consistent with accommodative spasms. A cycloplegic auto-refraction revealed significantly lower myopia present in both eyes than the initial pre-cycloplegic auto-refraction with minimal variability in readings. Symptomatic relief was achieved by cycloplegia and spectacle correction.