a 7-year - old female presented complaining of intermittent diplopia and blurred vision for 2 months .
1 ) . however , variable degrees ( 10 to 30 prism diopters [ pd ] ) of esodeviation and miotic pupils were evident only at near fixation ( fig .
her esodeviation did not change with the addition of + 3.0 diopters ( d ) lenses .
however , cycloplegic refraction revealed that both eyes were nearly emmetropic ( + 0.5 d ) .
the patient also complained of frequent headaches and abdominal pain ; the results of all physical and neurological examinations were normal , including a brain magnetic resonance imaging with contrast .
the patient was diagnosed with convergence spasms and was referred to the psychiatry department for her somatic complaints . plus lenses ( + 1.5 d ) for reading were prescribed for atropinization of her eyes .
one month after prescribing atropine eyedrops and reading glasses , the patient 's best corrected visual acuity increased to 20/20 .
she continued to complain of intermittent diplopia , but the frequency and duration were decreased .
however , the patient 's mother did not bring her daughter to the psychiatric department ; the patient was again referred to the department of psychiatry . during a mental status examination at the department of psychiatry ,
the patient was given a psychiatric diagnosis of childhood emotional disorder owing to an emotionally unavailable mother suffering from major depressive disorder .
( antidepressants , selective serotonin reuptake inhibitor [ ssri ] ) and diazepam 2 mg p.o .
( anxiolytics , benzodiazepine ) for the patient . additionally , escitalopram 10 mg p.o .
one month after initiation of the antipsychotic medications , the patient 's esodeviation at near fixation was resolved and all somatic complaints had ceased ( fig .
the patient 's visual acuity was 20/20 without glasses and her refraction was nearly emmetropic ( + 0.5 d ) .
as such , successful cessation of the atropinization of the patient 's eyes was achieved after only 2 months .
after the patient and her mother finished 6 months of the antipsychotic medication regimen , no symptoms were evident of either convergence spasms or any other somatic disorders .
most convergence spasm cases are caused by a functional disorder , such as hysteria or neurosis .
. emotional instability may result in a variety of ocular manifestations besides convergence spasms , such as blurred vision , monocular diplopia , tunnel vision , blepharospasm , and nystagmus .
emotional instability should be considered as a possible cause when patients present with these symptoms . if no signs of emotional problems are present , a thorough neurological work - up is recommended .
there are several organic causes of convergence spasms , including encephalitis , tabes , labyrinthine fistulas , arnold chiari malformation , posterior fossa neurofibroma , trauma , and pituitary adenoma .
some authors have reported positive outcomes from supportive psychotherapy and amytal interviews . however , the conventional therapy for convergence spasms consists of atropinization of the eyes and the prescription of plus lenses for near vision .
it is useful to produce cycloplegia in an attempt to break the cycle of sustained maximal convergence and accommodative spasm .
dilated pupils can lead to photophobia and blurred vision with near fixation and the wearing of reading glasses can cause discomfort .
other adverse events may include allergic conjunctivitis and , rarely , fever and aggravation of asthma . in the present case ,
the successful cessation of the atropinization of the patient 's eyes was achieved only one month after the patient and her mother initiated antipsychotic medications . of course
these events may occur early in treatment with a high dose ( > 100 mg ) of the drug or following the addition of drugs that inhibit the metabolism of ssris .
in addition , some patients also experience ataxia ( < 2% ) and dizziness ( < 1% ) with benzodiazepines .
however , most benzodiazepines , especially low potency benzodiazepines like diazepam , are generally well tolerated .
the low dose and low potency of the antipsychotic medications given to the present patient did not elicit any of these side effects .
we report a case of early resolution of convergence spasms after the addition of antipsychotic medications .
additional treatment for childhood emotional disorder , which was the indirect cause of the patient 's convergence spasms , reduced the required duration of atropinization of the eyes from one year to 2 months .
we recommend active referral and collaboration with psychiatrists when treating patients whose disease may be functional in origin .
 we report a case of early resolution of convergence spasms following the addition of antipsychotic medications and present it as a possible alternative to the conventional treatment for convergence spasms . 
 the cessation of atropinization of the eyes and the use of reading glasses was achieved after only 2 months following the initiation of antipsychotic medications for childhood emotional disorder . 
Case Report
Discussion