Spasm of Near Reflex in a Patient with Autism Spectrum Disorder: A Case Report
Satoshi Ueki,
Yukari Hasegawa,
Tetsuhisa Hatase,
Takako Hanyu,
Jun Egawa,
Atsushi Miki,
Takeo Fukuchi
Affiliations
Satoshi Ueki
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Yukari Hasegawa
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Tetsuhisa Hatase
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Takako Hanyu
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Jun Egawa
Department of Psychiatry, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Atsushi Miki
Department of Ophthalmology, Kawasaki Medical School, Matsushima 757, Okayama 701-0192, Japan
Takeo Fukuchi
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-dori 1-757, Chuo-ku, Niigata 951-8510, Japan
Spasm of near reflex (SNR) involves intermittent spasm of one or more of the three near reflex components. Psychiatric disorders are one cause of SNR. We describe a patient with SNR diagnosed with autism spectrum disorder (ASD). A 36-year-old male with esotropia since childhood was referred due to headache and dizziness. The alternate prism cover test showed 30 prism diopters at both near and distant fixation. Four months after his first visit, he was diagnosed with ASD. Twenty-nine months after his first visit, he underwent strabismus surgery to treat concomitant esotropia. Postoperatively, the angle of strabismus improved but remained variable. Because the angle of strabismus varied, we suspected SNR; the diagnosis was performed after evaluating the patient’s microfluctuations in accommodation with Speedy-K. However, it was difficult to distinguish convergence spasm from concomitant esotropia in this patient because he has had a history of esotropia since childhood. In a patient with concomitant esotropia, if the symptoms are not exclusively due to strabismus, SNR should be suspected. Although the relationship between SNR and the pathology of ASD is unknown, it is possible that patients with ASD are more likely to develop SNR.
