Spasms of accommodation and convergence are usually functional in nature, but are occasionally the result of a severe head injury or part of a dorsal midbrain syndrome. A highly variable (moment-to-moment) esotropia is accompanied by pupillary miosis and accommodative myopia. When binocular horizontal pursuit movements are tested, the adducting eye takes up fixation in either direction. This pseudo-abducens palsy is usually enhanced during cover/uncover testing (■ Fig. 10.8). The spasms can last for a few seconds or for several hours. In addition to the blurring and diplopia, headache is associated with the longer lasting spasms.
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