Convergence Insufficiency and Square Wave Jerks in PSP

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-yo-woman with progressive supranuclear palsy with complaints of difficulty reading. Her husband noticed that she would frequently close one eye when attempting to read, and words were not clear on the page, and this would in fact improve by covering one eye. On her exam, she had a 1 prism diopter (PD) esodeviation with Maddox rod testing at distance (difficult to appreciate subtle refixation saccades with alternate cover testing due to her square wave jerks), and with alternate cover testing at near, there was a 10 PD exotropia. Additionally, her near point of convergence was about 20 cm (normal is <10 cm), and her convergence amplitude was 4 PD (base out prism - normal is >15 PD). Convergence insufficiency is common following concussion/TBI or with parkinsonism. Square wave jerks are common in PSP, and hers are shown here as well. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This is a 70-year-old woman with progressive supranuclear palsy with complaints of diffculty reading. Her husband noticed that she would frequently close one eye when attempting to read while she noticed that words were not clear on the page, although this improved by covering one eye. On her exam, she was orthophoric at distance and had a symptomatic (experienced diplopia) exotropia at near (>10 prism diopters). Additionally, her near point of convergence was about 20 cm (normal is <10 cm), and her convergence amplitude was 4 PD (base out prism - normal is >15 PD). Convergence insuffciency is common following concussion/TBI or with parkinsonism. Square wave jerks are common in PSP, and hers are shown here as well. https:// collections.lib.utah.edu/ark:/87278/s6m07z61