Physical Exam

Convergence

also known as Near point of convergence (NPC) test

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Video coming September 2026

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

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:Limited

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:Limited

Vestibular Migraine

Receded near point of convergence

Rule in

—

Rule out

Very helpfulDerived CI

Evidence:Limited

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.
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.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
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.