Datu, Justine Louis C.

OD3B

Anomalies of Accommodation

Accommodation

 Reflex of the eye where the ciliary muscles contract causing the convergence of the eyes and increase in the

biconvexity of the crystalline lens thus, increasing the dioptric power of the eye

Anomalies

1. Accommodative fatigue – apart from the overuse, factors that influence onset of fatigue include the ff:

 Refractive status

 Relationship with convergence

 Symptoms

 Asthenopia

 Treatment of fatigue

 Correct significant ametropia

 Correct significant OMB anomaly

 Visual hygiene

 Consider orthscopic spectacles

Failure of Accommodation

2. Presbyopia – condition of a physiological insufficiency of accommodation leading to a progressive fall in near

vision

 Pathophysiology – in emmetropic eye, far point is infinity and near point varies with ages

 Causes

o Age-related changes in lens

o Decrease in elasticity of lens capsule

o Increase in size and hardness of lens substance

o Age- related decline in ciliary muscle power

 Symptoms

 Reading difficulty in poor light

 Tired eyes after reading

 Blurred vision
 Treatment

 Prescribe correction so that near point focus is brought within normal working distance

3. Prespyopia

 Objective – dynamic retinoscopy

 Subjective

o Complete distance refraction

o Measures amplitude of accommodation

o Use amplitudes as a starting point to calculate an approximate reading addition

4. Pre-senile cataract

 Cataract is likely to reduce accommodation

 May be unilateral

 Unequal reading adds

 May have reduced VA

5. Insufficiency of Accommodation – condition in which accommodative power is constantly less than lower limit

of normal range according to patient’s age

 Symptoms

 Asthenopia

 Blurred vision for near work

 Over- or – under- convergence

 Treatment of Insufficiency

 Identification and treatment of any systemic cause

 Full spherical correction due to excess convergence

 Base in prisms could be added if there is convergence insufficiency

 Prismatic correction

 Weakest convex lens should be prescribed

 Accommodative exercises

6. Sustained Accommodation – amplitudes are normal but rapidly diminish with use

7. Ill- sustained accommodation

 Common cause – debilitating illness

 Investigation and treatment – in the same way as insufficiency

8. Paralysis of Accommodation

 Signs and symptoms

 Blurred vision
  Micropsia

 Reduced amplitude of accommodation

 Treatment

 Self-recovery occurs in drug induced paralysis

 Dark glasses are effective in reducing glare

 Convex lenses for near vision may be prescribed

9. Spasm of Accommodation – tone of ciliary muscle is increased and a constant accommodative effort is

expended by the parasympathetic nervous system

 Symptoms

 Blurred vision

 Macropsia

 Asthenopia during close work

 Pain

 Poor concentration

 Miosis

 Convergence anomalies

10. Functional Spasm

 Response to over fatigue and “eye strain”

 Bad visual hygiene

 Optical or ocular motor difficulties

 Treatment

 Eliminate exciting cause

 Consider general health, mental state

 Correct refractive error and/or ocular motor anomaly

11. Organic Spasm – irritation of parasympathetic system

 Treatment

 Manage the cause

Purkinje – sanson Image

Purkinje imagesare reflections of objects from the structure of the eye. They are also known as Purkinje

reflexes and as Purkinje-Sanson images. At least four Purkinje images are usually visible. The first Purkinje image

(P1) is the reflection from the outer surface of the cornea. The second Purkinje image (P2) is the reflection from

the inner surface of the cornea. The third Purkinje image (P3) is the reflection from the outer (anterior) surface of

the lens. The fourth Purkinje image (P4) is the reflection from the inner (posterior) surface of the lens. Unlike the

others, P4 is an inverted image.

Purkinje-Sanson images are named after Czech anatomist Jan Evangelista Purkyně (1787–1869) and

after French physician Louis Joseph Sanson (1790–1841).

The third and fourth Purkinje images can be visible from within the eye itself. Light reflected away from the surfaces

of the lens can in turn reflect back into the eye from the rear surface of the cornea. These images are,

therefore, entoptic phenomena.

The first and fourth Purkinje images are used by some eye trackers, devices to measure the position of an eye.

The cornea reflection (P1 image) used in this measurement is generally known as glint.