A 26-year-old man was seen because of his complaint of constant blurring of vision at distance for five days. The blurring was due to three diopters of pseudomyopia associated with attempts to overcome a marked convergence insufficiency and exotropia due to ocular myasthenia gravis. Pyridostigmine therapy brought improvement but not resolution. Pseudomyopia associated with a true spasm of accommodation has been described previously in this condition. This patient, however, did not have a true spasm of accommodation. His pseudomyopia was ascribed to "substitute convergence" to compensate for marked myasthenic weakening of the medial recti muscles.
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