Physical examination maneuver

Physical Exam

Convergence

also known as Near point of convergence (NPC) test
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How to Perform

Hold a target, such as your fingertip or a pen, about an arm’s length in front of the patient and ask the patient to keep it in focus as you move it slowly toward the bridge of the nose. Watch both eyes turn inward and observe the pupils. Identify the near point of convergence, the point at which one eye can no longer maintain fixation and drifts outward.

How to Interpret

Showing 3 of 4 findings

Prolonged Concussion Recovery

Receded near point of convergence (>6 cm) at the initial visit in an athlete with established sport-related concussion, predicting prolonged recovery of 28 days or more
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate

Serious Eye Disease

Photophobia on convergence (finger-to-nose test) in a patient with a red eye
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Moderate

Vestibular Migraine

Receded near point of convergence
Rule in
Very helpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

AccommodationMembers
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Accommodation
Rule in:HConcussion, IEAdie Tonic Pupil, IEConvergence Insufficiency +4 more
Rule out:NHConcussion, IEAdie Tonic Pupil, IEConvergence Insufficiency +4 more
Eye InspectionMembers
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Eye Inspection
Rule in:VHHyperthyroidism, VHStroke, HSerious Eye Disease +18 more
Rule out:HConjunctivitis, SHHypovolemia, MHAnemia +18 more
Pupillary Light ReactionMembers
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Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
Red ReflexMembers
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Red Reflex
aka Brückner test
Rule in:VHAnisometropia, VHMedia Opacity, VHStrabismus +1 more
Rule out:VHMedia Opacity, SHAnisometropia, MHStrabismus +1 more
Extraocular MovementsMembers
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Extraocular Movements
Rule in:VHStroke, SHHyperthyroidism, SHMyasthenia Gravis +9 more
Rule out:HMyasthenia Gravis, SHHyperthyroidism, NHOrbital Fracture +9 more
Mouth and Tongue InspectionMembers
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Mouth and Tongue Inspection
Rule in:HHypoxemia, SHAnemia, SHHepatopulmonary Syndrome +16 more
Rule out:HHepatopulmonary Syndrome, SHHypovolemia, MHAnemia +16 more

Related Systems / Regions

Head, Eyes, Ears, Nose, ThroatNeurological

Related Diagnoses

Convergence InsufficiencyProlonged Concussion RecoverySerious Eye DiseaseVestibular Migraine

Related Chief Complaints

Blurred Vision When ReadingBrain FogDifficulty ConcentratingDifficulty Focusing Up CloseDizzinessDizziness with HeadacheDouble Vision When ReadingEpisodes of VertigoEye FatigueEye PainEye Pain When Focusing Up CloseEye RednessEye StrainFatigueHeadache with ReadingIrritabilityLight SensitivityLoss of Place When ReadingMemory ProblemsMotion SensitivityNauseaOngoing DizzinessPainful Red EyePersistent Headache After a Head InjuryProlonged Concussion SymptomsRed EyeSleep DisturbanceSlowed ThinkingSound SensitivitySpinning SensationTired EyesTrouble Concentrating When ReadingUnsteadinessVertigoWords Moving on the Page

References

  • Zuma e Maia FC, Ramos BF, Bittar RSM, Cal RVR, Luis LA, Mangabeira Albernaz PL. The near point of convergence in patients with vestibular migraine. Int Arch Otorhinolaryngol. 2025;29(1). doi:10.1055/s-0044-1791643. PMID 39911940.
  • DuPrey KM, Webner D, Lyons A, Kucuk CH, Ellis JT, Cronholm PF. Convergence insufficiency identifies athletes at risk of prolonged recovery from sport-related concussion. Am J Sports Med. 2017;45(10):2388-2393. doi:10.1177/0363546517705640. PMID 28511593.
  • Talbot EM. A simple test to diagnose iritis. Br Med J (Clin Res Ed). 1987;295(6602):812-813. doi:10.1136/bmj.295.6602.812-a. PMID: 3676686.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Narayana S, McGee S. Bedside diagnosis of the 'red eye': a systematic review. Am J Med. 2015;128(11):1220-1224.e1. doi:10.1016/j.amjmed.2015.06.026. PMID: 26169885.
  • Raghuram A, Cotter SA, Gowrisankaran S, Kanji J, Howell DR, Meehan WP 3rd, Shah AS. Postconcussion: receded near point of convergence is not diagnostic of convergence insufficiency. Am J Ophthalmol. 2019;206:235-244. doi:10.1016/j.ajo.2019.04.008. PMID 31004592.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.
  • Talbot EM. A simple test to diagnose iritis. BMJ. 1987;295:812-813. PMID 3676686.

Research last updated September 9, 2026.