Convergence Spasm: Patient Education
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Title: Convergence Spasm: Patient Education
Author:Jared Tuttle, BS; Madison Perchik, MD
Date: Sep 29th, 2025
Keywords/Main Subjects: Convergence spasm, patient education, accommodative spasm, spasm of the near reflex
Identifier: Moran_CORE_128225
Copyright statement: Jared Tuttle, Madison Perchik, ©2025. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/
References:Kung FT, Lai CW. Convergence spasm. Neurology. 1983;33(12):1636-1637. doi:10.1212/wnl.33.12.1636-a. Szczęśniak M, Sikorska E, Rajca M, et al. The etiology, diagnostics, and treatment of the spasm of the near reflex – a narrative review. Eur J Ophthalmol. 2024;34(6):1655-1666. doi:10.1177/11206721241237309. Manna P, Karmakar S, Bhardwaj GK, Mondal A. Accommodative spasm and its different treatment approaches: A systematic review. Eur J Ophthalmol. 2023;33(3):1273-1286. doi:10.1177/11206721221136438. Papageorgiou E, Kardaras D, Kapsalaki E, Dardiotis E, Mataftsi A, Tsironi EE. Spasm of the near reflex: a common diagnostic dilemma?. Int J Ophthalmol. 2021;14(4):541-546. Published 2021 Apr 18. doi:10.18240/ijo.2021.04.10. Roy S, Bharadwaj SR, Patil-Chhablani P, Satgunam PN. Spasm of near reflex: a comprehensive management protocol and treatment outcomes. J AAPOS. 2021;25(3):162.e1-162.e6. doi:10.1016/j.jaapos.2021.02.010.
What is convergence spasm?
Convergence spasm is a condition in which the eyes inappropriately activate the normal “near response,” which is usually used when focusing on a close object. This response includes the eyes turning inward (converging toward the nose), the pupils getting smaller, and the lenses inside the eye changing shape to focus at near. In convergence spasm, however, these actions occur at the wrong times, leading to visual symptoms. For example, these changes can occur while one is trying to focus on something far away, resulting in blurry and possible double vision. The condition is also known as accommodation spasm or spasm of the near reflex.
What are the signs and symptoms of convergence spasm?
People with convergence spasm may experience:
- Blurry vision at distance, near, or both.
- Double vision (usually two side by side images) that may worsen when looking at objects far away.
- Eye strain or headaches, especially when reading or trying to focus
- Intermittent symptoms—episodes may come and go, sometimes lasting minutes or longer. They may have an identifiable trigger, such as reading, stress, or fatigue.
On exam, doctors may notice:
- Eyes crossing inward when not focusing at near. The amount of crossing can be variable.
- Pupil size can decrease while the patient experiences symptoms.
Do patients need additional work-up?
Extensive work-up is not recommended for otherwise healthy patients. Most cases of convergence spasm do not need head imaging or labs. The cause is usually functional—meaning it is not due to structural brain or eye problems. Symptoms may correlate with high stress, excessive screen time, anxiety, or fatigue.
However, it is important to rule out secondary causes. Rarely, convergence spasm can be linked to:
- Neurological conditions, such as myasthenia gravis, multiple sclerosis, or a brain injury.
- Medications (such as cholinergic or antipsychotic medications)
- Uncorrected refractive error (need for glasses)
- If you have additional symptoms, such as weakness, numbness, difficulty walking, or speech problems, your doctor may order imaging or blood tests to rule out other causes.
Treatments
Treatments aim to reduce potential triggers:
- Education: For many patients, understanding the condition is the most important step and can lead to a complete resolution of symptoms.
- Relaxation and stress management: Since anxiety or fatigue can trigger symptoms, techniques such as mindfulness, breathing exercises, or professional counseling/therapy may help. Although a specific psychological stressor may not be obvious at first, these techniques can help calm the mind and prevent unhelpful triggers.
- Medication: Temporary use of dilating eye drops (e.g., atropine, cyclopentolate) can decrease the eye’s ability to focus on near objects, thereby blunting the spasm of the near reflex, relaxing the eyes, and reducing the frequency of episodes.
- Temporary glasses (plus lenses): Glasses with magnifying lenses reduce the eye’s need to focus strongly. When reading, these glasses can be worn to help prevent additional episodes.
- Prism glasses or patching: If double vision is particularly bothersome, prism glasses or patching may be recommended for select patients.
- Regular Follow-up: Checking in regularly can help patients and doctors track improvement over time and address associated symptoms.
- Address secondary causes: If related to a neurologic disease or medication, treating the root cause or removing the offending medication can improve symptoms.
Prognosis
- Most patients with convergence spasm do very well once the diagnosis is made and patients understand the condition. However, full recovery may take time. Moderate or severe cases may require months to years of treatment and follow-up.
- Symptoms may come and go, especially during times of elevated stress or associated triggers.
Faculty Approval By: Srav Vegunta, MD
