# Spasm of Near Reflex in a Patient with Autism Spectrum Disorder: A Case Report

## TL;DR

A 36-year-old man with autism spectrum disorder and a history of esotropia was found to have spasm of near reflex, suggesting a possible link between the two conditions.

## Contribution

This case report highlights a potential association between spasm of near reflex and autism spectrum disorder.

## Key findings

- The patient exhibited symptoms of spasm of near reflex despite a long history of esotropia.
- The diagnosis of spasm of near reflex was confirmed using microfluctuations in accommodation measured with Speedy-K.
- The patient was later diagnosed with autism spectrum disorder, suggesting a possible connection between the two conditions.

## Abstract

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.