Convergence insufficiency and failure of accommodation following midfacial trauma

A prospective evaluation of patients who had sustained midfacial trauma was carried out in order to determine the prevalence of impaired convergence and accommodation and to establish the risk factors for such defects. Of 52 patients in this study, 11 suffered accommodation and/or convergence disturbances. They included 6 males (17% of the male population) and 5 females (29% of the female population). Nine of these 11 patients sustained their injuries due to alleged assaults (24.3% of all assaulted patients) and 2 following simple falls (25% of all fall victims). Five patients complained of double vision for near (5/11 = 45.5%) and another 4 had blurred vision and/or difficulty with reading (4/11 = 36.4%). The remaining two were asymptomatic. Six patients were randomly selected to receive orthoptic exercises/treatment while the other five were monitored for signs of spontaneous recovery. Within six months of injury/surgery, 83% of the treated patients (n = 5) and 80% of the non-treated patients (n = 4) recovered to within the normal values of accommodation and convergence. No significant statistical relationship was found between the incidence of accommodation and/or convergence failure, and the cause or the type of fracture sustained. It may, however, be related to the severity of both the impact and the associated closed head trauma.