This leaflet explains an imbalance of brain function systems that can cause signs such as small pupils, a variable inward turn of the eye often with symptoms of blurred and / or double vision.
What is Near Reflex Spasm?
When we look at close objects three things usually happen: our eyes naturally focus on that object, the pupils get smaller and both the eyes turn in towards the nose. This allows us to see a close object as single and clear. It is called the near reflex triad.
Near reflex spasm happens when there is an imbalance in this triad causing signs such as small pupils and a convergent squint (inward turn of the eyes) to occur frequently.
People may have problems with:
- blurred vision
- double vision
- change in image size
These symptoms are very real but it is not known what causes them. There appears to be an interruption to the nervous pathways in the brain – a problem with the functioning of the nervous system which is often called a ‘functional neurological problem’. In some ways, this can be compared to a computer software problem rather than a hardware problem.
What causes problems with the near reflex?
Near reflex spasm is very often related to increased close work, stress or some other psychological difficulty that you may not even be aware of. Sometimes the problem cannot be identified.
What treatment is there?
There is no effective eye treatment for this condition and treatment is best directed towards the underlying trigger e.g. stress or other emotional problems. Sometimes the knowledge that there is no physical problem can result in symptoms reducing or disappearing. Recognising triggers that cause the spasm can be very helpful in reducing symptoms. Psychological help may be beneficial.
It is important to ensure you are wearing the correct glasses. We will sometimes do a test with eye drops to check this. This stops you focusing and makes the pupils dilated for a period of time.
In cases where short term relief is needed, such as during exam periods for students, we may try to reduce the spasm by paralysing the focussing of the eye with eye drops. As the drops stop you from focussing, glasses are then needed for reading. You might be aware of glare from bright lights. This treatment can be of limited success and is only carried out for a short amount of time.
There are some links to further information and support at the end of this leaflet.
