Certified Ophthalmic Medical Technologist (COMT) Practice Exam

A patient shows an exophoria at near but is orthophoric at distance. What condition might this indicate?

1. Convergence Insufficiency

2. Divergence Excess

3. Accommodative Insufficiency

4. Exophthalmic Goiter

The correct answer is: Convergence Insufficiency

Exophoria at near indicates that the patient's eyes are positioned outwardly when they are focused on a nearby object, suggesting a tendency for the eyes to diverge rather than converge during near work. Being orthophoric at distance means that there is no misalignment when focusing on objects far away. This combination of findings typically points to convergence insufficiency, where the eyes do not converge adequately for near tasks, leading to exophoria. In convergence insufficiency, the eyes struggle to maintain proper alignment when viewing closer objects, often resulting in symptoms like eye strain, double vision, and difficulty reading. This condition is characterized specifically by a misalignment that becomes apparent under conditions of near visual demand, while the alignment is normal at distance viewing. This is significant because it helps to pinpoint the nature of the binocular vision issue, differentiating it from other conditions that could cause similar symptoms. The other options relate either to conditions affecting distance vision or to other aspects of eye muscle and alignment functioning that do not align with the presented symptoms of exophoria at near and orthophoria at distance.