A 20-year-old student complains of eyestrain and blurred vision after 20 minutes of reading. Cover test shows an exophoria of 12 prism diopters at near and 2 prism diopters at distance, with reduced positive fusional vergence reserves. First-line treatment is:
- A Base-in Fresnel prisms for reading
- B Recession-resection surgery on both medial recti
- C Pencil push-up convergence exercises ✓
- D Full hypermetropic spectacle correction
Correct answer: C. Pencil push-up convergence exercises
Explanation
Convergence insufficiency is defined as a remote near point of convergence, exophoria greater at near than distance by about 10 prism diopters or more, and low positive fusional vergence. The standard first-line treatment is orthoptic exercises such as pencil push-ups or home-based vergence training, which strengthen fusional convergence. Prisms are avoided because they reduce the demand on weak convergence and worsen the problem over time. Surgery is reserved for rare refractory cases.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.