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The cause of congenital fourth nerve palsy is unclear in most cases. It may be neurogenic in origin, due to a dysgenesis of the CN IV nucleus or nerve, but a clinically similar palsy may result from absence or mechanical dysfunction (e.g., abnormal laxity) of the superior oblique tendon.
Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for causing contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye. [1]
Refractive errors – distance and near deviation approximately equal. Divergence excess - exodeviation is more than 15 dioptres greater for distance than near deviation. Convergence insufficiency – near exodeviation greater than distance deviation. These can be due to nerve, muscle, or congenital problems, or due to mechanical anomalies.
A large-scale randomized clinical trial known as the Convergence Insufficiency Treatment Trial (CITT) found that office-based vision therapy combined with at-home therapy was more effective than placebo therapy (in-office placebo treatments) for improving symptoms and clinical signs of convergence insufficiency in children and adults.
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AI is generally considered separate from presbyopia, but mechanically both conditions represent a difficulty engaging the near vision system (accommodation) to see near objects clearly. Presbyopia is physiological insufficiency of accommodation due to age related changes in lens (decreased elasticity and increased hardness) and ciliary muscle ...