I need advise with followed case

CLINICAL CASE:


Woman, 21 years old. She is tired when she does close work tasks . With eye pain and blurred vision in near and distance vision. She works at a workshop of optics mounting glasses, she gets tired when she needs to mount rimless glasses and make welds with very small objects. She does not use a lot of light and does a very close distance work. She complains of photophobia. She has been diagnosed with migraines, she does not have them frequently and they are not very painful but she sees black spots that prevent her from seeing (the last episode occurred 2-3 years ago) and half of her visual field disappears, but she does not know from which eye. When she was little, one of her eyes was covered but she does not know which one. Her sister deviated one eye.


VAunaided distance 1.2/1.2.

VAunaided near 20/20 both eyes.


Retinoscopy RE 160-0.25+0.75 and LE 20-0.25+0.75

Subjective RE 165-0.25+0.50:1.0+

LE 30-0.25+0.50: 1.0+


9 hours before going to work


CT distance Ortho

CT near eso

NPC 8cm


Distance vision phoria 3 eso

Reserves Base in x/12/10

Base out x/20/12

Vergence flexibility 6 Base in – she sees simple, but not clear 12 Base out - she sees simple, but not clear



Near vision phoria 10 eso

Reserves Base in x/22/14

Base out x/30/20

Vergence flexibility 12 base in, does not fusion

8 base out fusions, but has some difficulties to see clear.

14 base out fusions, but has some difficulties to see clear.

Impossible to see clear without correction nor with any prism. The patient is tired.


Accommodative flexibility RE automatic

LE automatic

Binoc: dificult simple and impossible clear with minus lenses.

Delay +0.50

Stereopsis (Titmus – Wirt) 140’’


After the examination, near vision is of 0.8 in both eyes.


What is the diagnosis? Which are the treatment options?