Paralysis of the near-vision triad in a child

The near-vision triad, or complex, consists of convergence, miosis, and accommodation. Neuronal pathways that control each of these components are distinct but interrelated. Abnormalities affecting 1 or more components of the complex may present as eye pain, headache, blurred vision, or diplopia at near fixation. Although isolated abnormalities in any one of the components are common, a severe and concurrent defect in all three is rare.(1,2) We describe an 11-year-old child who presented with complete paralysis of the near triad without identifiable neurological defect. The child benefited from prism and plus lenses. To our knowledge, only three previous reports have described patients with idiopathic paralysis of convergence and accommodation in healthy children.(2-4) The methods we used to objectively confirm defects in the near-vision complex and rule out a psychogenic etiology may be instructive to other clinicians.