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Watery Eyes Always?

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Lydia T (F/11) came for follow up, vision with existing glasses is fine seeing far & near. She reported that she can still see fine without glasses previously but she will need to wear her glasses to see far better now. She also said that her eyes always tend to tear up starting at noon.

Vision without glasses
R: 6/15
L: 6/18-

Existing glasses of 2+ years
R: +1.00/-2.75×180 (6/7.5+) R>L
L: +0.75/-2.75×180 (6/7.5-)
Near: L>R

Other assessments show:

Random Dot 3S
12.5″ (slow)

Cover Test
Distance: NMD
Near: moderate XP, moderate recovery

Howell Card
Distance: 0 – 2 XP
Near: 14 XP (blink: 10 XP)
+1.00 Near: 18 XP
-1.00 Near: 14 XP
+2.00 Near: 18 XP
-2.00 Near: 12 XP

NRA 
+1.50
(blurry mono & bino)

PRA 
-1.50
(blurry mono & bino)

NPC
RE deviates @10cm

AA
R: 15D, 15D, 15D
L: 16D, 16D, 16D

Accommodation Facility (+/- 2.00) 
BE: 7 cpm, difficult minus lens
R: 7 cpm, difficult minus lens
L: 11 cpm, difficult minus lens

MEM
R: +1.00 (dim)
L: +0.75

Fusional Reserves
Near, PFV: x/16/6
Near, NFV: x/20/18
Distance, NFV: x/10/8
Distance, NFV: x/14/12

Vergence Facility
Near: 1 cpm (double BO)
Distance: 13 cpm

Interpupillary distance, IPD = 6.2cm

Notes

Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th

Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards
ACT: alternating CT

Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37

Convergence, NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)

Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)

Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/NFV: x/4-10/2-6

Vergence Facility  – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)

Random Dot 3S  – 3D Vision 
12.5″