Failure of accommodation due to palsy of the ciliary muscle.
Etiology: This rare disorder is primarily to one of the following causes:
❖ Iatrogenic drug-induced palsy due to parasympatholytic agents such as atropine, cyclopentolate scopolamine, homatropine, and tropicamide.
❖ Peripheral causes: Oculomotor palsy, lesions of the ciliary ganglion, or the ciliary muscle.
❖ Systemic causes: Damage to the accommodation center in diphtheria, diabetes mellitus, chronic alcoholism, meningitis, cerebral stroke, multiple sclerosis, syphilis, lead or ergotamine poisoning, medications such as isoniazid or piperazine, and tumors.
Symptoms: The failure of accommodation leads to blurred near vision and may be associated with mydriasis where the sphincter pupillae muscle is also involved. The clinical syndromes listed below exhibit a specific constellation of clinical symptoms and therefore warrant further discussion.
❖ Post-diphtheria accommodation palsy: This transitory palsy is a toxic reaction and occurs without pupillary dysfunction approximately four weeks after infection. Sometimes it is associated with palsy of the soft palate and/or impaired motor function in the lower extremities.
❖ Accommodation palsy in botulism: This is also a toxic palsy. It does involve the pupil, producing mydriasis, and can be the first symptom of botulism. It is associated with speech, swallowing, and ocular muscle dysfunction accompanied by double vision.
❖ Tonic pupillary contraction is associated with tonic accommodation.
❖ Sympathetic ophthalmia is characterized by a decrease in the range of accommodation, even in the unaffected eye.
H Measurement of the range of accommodation is indicated whenever sympathetic ophthalmia is suspected.
Diagnostic considerations: In addition to measuring the range of accommodation with an accommodometer, the examiner should inquire about other ocular and general symptoms.
Treatment: This depends on the underlying disorder.
Prognosis: The clinical course of tonic pupillary contraction is chronic and results in irreversible loss of accommodation. The toxic accommodation palsies are reversible once the underlying disorder is controlled.
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