This can be:

• Night myopia
• Accommodative instability
• Fragile binocularity
• Often cataract
• Often large, physiologic pupils.

A thorough examination including refraction, accommodative functions, fusional skills assessment.

A thorough ocular health evaluation including dilated assessment of the crystalline lens.

Measure pupils under dim ambient lighting if pupils in dim are greater than 5.5 or 6.0 mm, consider aberrations of the eye may be responsible.

Management

Reassurance.

The patient should be encouraged to reduce all forms of stimulants several hours before night driving.

The patient should be encouraged to consider if night driving can be avoided.