What is the most common binocular dysfunction associated with a TBI?

• A. Convergence excess
• B. Convergence insufficiency
• C. Hyper deviation
• D. Accommodative infacility

Answer: (B)

Convergence insufficiency is the most common binocular dysfunction after a traumatic brain injury. When the brain is hurt, the neural pathways that coordinate eye movements for near tasks can be disrupted, making it hard for the eyes to converge together for close work. This shows up as an exophoria or insufficient recovery of convergence at near, along with a reduced ability to use positive fusional vergence to keep both eyes aligned during reading or computer use. The near point of convergence is often receded, and patients typically report headaches, eye strain, or diplopia with near tasks.

Convergence excess would involve too much inward turning or problems with near alignment in the opposite direction, which is not the typical pattern after TBI. A hyper deviation is a vertical misalignment and isn’t the common binocular issue seen post-injury. Accommodative infacility can occur, but it’s less consistently associated with TBI than convergence insufficiency, which is why it’s considered the primary dysfunction in this context.