A 10-year-old child complains of headache and difficulty reading. Cycloplegic refraction shows +3.50 D in both eyes. The manifest refraction (without cycloplegia) was +0.50 D. This difference represents:
- A Latent hypermetropia (masked by ciliary tone, revealed only with cycloplegia) ✓
- B Absolute hypermetropia (cannot be overcome by accommodation)
- C Facultative hypermetropia (overcome by accommodation, causing asthenopia)
- D Pathological hypermetropia due to nanophthalmos
Explanation
Total hypermetropia is divided into manifest hypermetropia (correctable without cycloplegia) and latent hypermetropia (masked by persistent ciliary muscle tone and revealed only after cycloplegic refraction). The difference between cycloplegic (+3.50 D) and manifest (+0.50 D) refraction (= +3.00 D) is the latent component, which is constantly corrected by unconscious accommodation. In children with high latent hypermetropia, this excess accommodative effort causes asthenopic symptoms and convergent strabismus; cycloplegic refraction is therefore mandatory in all children before prescribing.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.