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NEUROLOGY 1976;26:1018
© 1976 American Academy of Neurology

Misdiagnosis of spasm of the near reflex

JOHN F. GRIFFIN, M.D., SHIRLEY H. WRAY, M.D., Ph.D. and DUNCAN P. ANDERSON, M.D.

From the Howe Laboratory of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston (Drs. Griffin and Wray), and the Department of Ophthalmology, Montreal General Hospital, Montreal (Dr. Anderson).

A bilateral sixth nerve palsy portends serious disease of the central nervous system and precipitates extensive patient studies. Spasm of the near reflex, characterized by intermittent convergence, accommodation, and miosis, is a functional disturbance. Five patients with hysterical spasm of the near reflex erroneously diagnosed as a bilateral sixth nerve palsy are reported. The pupillary sign, intense miosis on attempted lateral gaze, is emphasized as an important clue to the correct diagnosis. Despite extensive investigation, no disease of the central nervous system was found. Neurotic or hysterical features were evident in every patient.

Requests for reprints should be addressed to Dr. Griffin, Howe Laboratory of Ophthalmology, 243 Charles Street, Boston, MA 02114.

This project was supported by grant No. 5 To1 EY00089, awarded by the National Eye Institute, DHEW.

Received for publication December 31, 1975.




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