A 14 year old boy complains of pain during reading. On examination, his both eyes are normal and vision with Snellen’s reading is 6/5. He still complains of pain on occluding one eye. The diagnosis is :
## **Core Concept**
The question tests understanding of **binocular vision** and **strabismus**. The patient's symptoms suggest an issue related to the alignment or coordination of the eyes, rather than a problem with visual acuity.
## **Why the Correct Answer is Right**
The key detail here is that the patient experiences pain when reading and when one eye is occluded. This indicates a problem with **binocular single vision**, where the brain combines images from both eyes into a single perception. When one eye is covered, the patient experiences discomfort or pain, suggesting that the eyes are not aligned properly (**heterophoria** or **latent strabismus**). This condition becomes apparent when binocular vision is disrupted, such as during occlusion of one eye.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, conditions like **refractive errors** (e.g., myopia, hyperopia) or **anisometropia** could be considered. However, these conditions usually cause blurry vision rather than pain upon occlusion of one eye.
- **Option B:** Similarly, this option is not provided, but one might consider **convergence insufficiency**, which could cause discomfort during near work. However, it usually doesn't cause pain upon monocular occlusion.
- **Option C:** Without the specific option provided, it's hard to address directly, but generally, conditions not related to binocular vision or alignment wouldn't cause these specific symptoms.
- **Option D:** Assuming this is not the correct answer, one might think of **organic causes** like **retinal detachment** or **optic neuritis**, which would more likely present with visual disturbances rather than pain on occlusion.
## **Clinical Pearl / High-Yield Fact**
A crucial point to remember is that **heterophoria** (latent strabismus) can cause symptoms like headaches, eye strain, and diplopia (double vision) during prolonged visual tasks, especially when binocular vision is stressed or disrupted. The symptom of pain upon occlusion of one eye hints at an issue with how the eyes work together.
## **Correct Answer:** D. Heterophoria