Kothari Mihir, Mody Kruti, Walinjkar Jaydeep, Madia Jigna, Kaul Shalini
Aditya Jyot Eye Hospital, Maharashtra, India.
J AAPOS. 2009 Apr;13(2):202-3. doi: 10.1016/j.jaapos.2008.09.002. Epub 2008 Dec 12.
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.
近视力三联征，或复合体，由集合、瞳孔缩小和调节组成。控制这些组成部分的神经通路是不同的，但相互关联。影响该复合体一个或多个组成部分的异常可能表现为近注视时眼痛、头痛、视力模糊或复视。虽然任何一个组成部分单独出现异常很常见，但所有三个组成部分同时出现严重缺陷则很少见。（1,2）我们描述了一名11岁儿童，其出现近视力三联征完全麻痹，无明确的神经学缺陷。该儿童受益于棱镜和凸透镜。据我们所知，之前仅有三篇报告描述了健康儿童特发性集合和调节麻痹的患者。（2 - 4）我们用于客观确认近视力复合体缺陷并排除精神源性病因的方法可能对其他临床医生有指导意义。
