Impaired Accommodation 1641 Accommodation Spasm Definition

An accommodation spasm is defined as inadequate protracted contraction of the ciliary muscle.

Etiology: Accommodation spasms are rare. They may occur as functional impairment or they may occur iatrogenically when treating young patients with parasympathomimetic agents (miotic agents). The functional impairments are frequently attributable to heightened sensitivity of the accommodation center, which especially in children (often girls) can be psychogenic. Rarely the spasm is due to organic causes. In these cases, it is most often attributable to irritation in the region of the oculomotor nuclei (from cerebral pressure or cerebral disorders) or to change in the ciliary muscle such as in an ocular contusion.

Symptoms: Patients complain of deep eye pain and blurred distance vision (lenticular myopia).

Diagnostic considerations and differential diagnosis: The diagnosis is made on the basis of presenting symptoms and refraction testing, including measurement of the range of accommodation. This is done with an accom-modometer, which determines the difference in refractive power between the near point and far point. A differential diagnosis should exclude latent hyperopia. In children, this will frequently be associated with accommodative esotropia and accommodative pupil narrowing.

Treatment: This depends on the underlying disorder. Cycloplegic therapy with agents such as tropicamide or cyclopentolate may be attempted in the presence of recurrent accommodation spasms.

Prognosis: Iatrogenic spasms are completely reversible by discontinuing the parasympathomimetic agents. The prognosis is also good for patients with functional causes. Spasms due to organic causes require treatment of the underlying disorder but once treatment is initiated the prognosis is usually good.

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