Misdiagnosis of spasm of the near reflex

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Abstract
A bilateral 6th nerve palsy portends serious disease of the CNS and precipitates extensive patient studies. Spasm of the near reflex, characterized by intermittent convergence, accommodation and miosis, is a functional disturbance. Five patients with hysterical spasm of the near reflex erroneously diagnosed as a bilateral 6th nerve palsy were reported. The pupillary sign, intense miosis on attempted lateral gaze, was emphasized as an important clue to the correct diagnosis. Despite extensive investigation, no disease of the CNS was found. Neurotic or hysterical features were evident in every patient.

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