Spasm of Accommodation

A Spasm of accommodation (also known

as a ciliary spasm, an accommodation, or
accommodative spasm) - is a condition in
which the ciliary muscle of the eye
remains in a constant state of
contraction.
 Accommodation
Mechanism

IS THE PROCESS BY WHICH THE VERTEBRATE

EYE CHANGES OPTICAL POWER TO MAINTAIN A
CLEAR IMAGE OR FOCUS ON AN OBJECT AS ITS
DISTANCE VARIES.
 Cont.

A C C O M M O D A T I ON U S U A L L Y A C T S
LIKE A REFLEX, INCLUDING AS
P A R T O F T H E A C C O M M O D A T I ON -
VERGENCE REFLEX
 Accommodation in Animals
IT CAN ALSO BE CONSCIOUSLY CONTROLLED IN
MAMMALS, BIRDS AND REPTILES VARY THE
OPTICAL POWER BY CHANGING THE FORM OF
THE ELASTIC LENS USING THE CILIARY BODY.
 Cont.

FISH AND AMPHIBIANS VARY THE POWER

BY CHANGING THE DISTANCE BETWEEN A
RIGID LENS AND THE RETINA WITH
MUSCLES.
 Spasm of Accommodation
NORMAL ACCOMMODATION ALLOWS THE EYE TO
"ACCOMMODATE" FOR NEAR-VISION. HOWEVER, IN
A STATE OF PERPETUAL CONTRACTION, THE
CILIARY MUSCLE CANNOT RELAX WHEN VIEWING
DISTANT OBJECTS. THIS CAUSES VISION TO BLUR
WHEN ATTEMPTING TO VIEW OBJECTS FROM A
DISTANCE.
 Pseudomyopia

REFERS TO AN INTERMITTENT AND

TEMPORARY SHIFT IN REFRACTIVE ERROR OF

THE EYE TOWARDS MYOPIA.
 Cont.

FOCUS OF LIGHT IN FRONT OF THE RETINA IS DUE

TO A TRANSIENT SPASM OF THE CILIARY MUSCLE
CAUSING AN INCREASE IN THE REFRACTIVE POWER
OF THE EYE.
 Cont.

IT IS COMMON IN YOUNG ADULTS WHO HAVE ACTIVE

ACCOMMODATION, AND CLASSICALLY OCCURS AFTER
A CHANGE IN VISUAL REQUIREMENTS, SUCH AS
STUDENTS PREPARING FOR AN EXAM, OR A CHANGE
IN OCCUPATION.
 Diagnosis

REFRACTION USING A STRONG CYCLOPLEGIC

LIKE ATROPINE OR HOMATROPINE EYE DROPS
 Possible clinical findings
include:
 NORMAL AMPLITUDE OF ACCOMMODATION AND NEAR
POINT OF CONVERGENCE.

 REDUCED NEGATIVE RELATIVE ACCOMMODATION.

 DIFFICULTY CLEARING PLUS ON FACILITY TESTING.

 Symptoms of Spasm of
Accommodation

• INTERMITTENT BLURRING OF DISTANCE VISION

PARTICULARLY NOTICEABLE AFTER PROLONGED
PERIODS OF NEAR WORK.

• SYMPTOMS OF ASTHENOPIA.
 Factors that may trigger the
Accommodation spasm

• VISUAL OVERLOAD (TV, COMPUTER, STUDIES IN

THE EVENING);

• BAD LIGHTING AT THE WORKING PLACE;

• BAD DAY REGIMEN (NOT ENOUGH FRESH AIR

WALKS, SPORTS SLEEP);
 Cont.
• BAD EYES-TO-BOOK DISTANCE (30-35 CM OPTIMAL);

• WEAKNESS OF NECK AND BACK MUSCLES;

• BLOOD SUPPLY DISTURBANCE IN CERVICAL SPINE;

• BAD SIZING OF TABLE/CHAIR/CHILD’S HEIGHT;

 Cont.

• IRRATIONAL NUTRITION;

• VITAMIN DEFICIENCY

• LACK OF PHYSICAL ACTIVITY.

 Manifestation (Signs) of
accommodation spasm
• FAST FATIGUE WHEN WORKING WITH NEAR
LOCATED OBJECTS;

• BURNING OR SMARTING SENSATION, REDDENING

OF EYES;

• IMAGE LOCATED NEAR IS NOT CLEAR, THE ONE

FAR OFF IS BLURRED, DOUBLING SOMETIMES;
 Cont.

• A CHILD IS TIRED AT CLASSES SOONER,

LEARNING PROGRESS IS SLOW;

• HEADACHES, OFTEN MISTAKEN FOR

GROWING-UP ALTERATION.
 Preventive care

• TODAY THE ACCOMMODATION SPASM IS CONSIDERED TO

BE A MAJOR CAUSE OF CHILDREN’S MYOPIA.

• THE CHILD NOURISHMENT SHOULD INCLUDE FOOD RICH

IN VITAMINS AND MINERALS.

• THE EARLY PROPHYLACTIC AND TREATMENT OF

ACCOMMODATION SPASM CAN PREVENT MYOPIA
DEVELOPMENT.
 Treatments
• CYCLOPLEGIC EYE DROPS

• VISION TRAINING
•

• SURGERY

• [EXPERIMENTAL] NITROGLYCERIN AND NITRIC

OXIDE

• [EXPERIMENTAL] PERILLA FRUTESCENS EXTRACT

 Cycloplegic Eye Drops
(Dilation)

-SOME PATIENTS DO FIND RELIEF THROUGH THE

USE OF DAILY EYE DILATION WITH CYCLOPLEGIC
DROPS.
 Side Effect

 They often have BAK as a preservative ingredient,

which with daily use can erode the tear shield, "At
each administration of an eye drop containing
benzalkonium chloride, its detergent effect disrupts
the lipid layer of the tear film.
 Cont.

-THIS CANNOT BE REGENERATED AND CAN NO LONGER

PROTECT THE AQUEOUS LAYER OF THE TEAR FILM, WHICH
EVAPORATES EASILY. IN THESE CIRCUMSTANCES, THE
CORNEA IS EXPOSED AND EYE DRYNESS OCCURS.

-BENZALKONIUM CHLORIDE HAS A CELLULAR TOXICITY ON

CALICIFORM CELLS, ENTAILING A REDUCTION IN THE
AMOUNT OF MUCIN, AN ADDITIONAL REASON FOR
DISRUPTING THE TEAR FILM
 Cont.

ONE SIDE EFFECT IS BLURRED VISION SINCE THESE

INDUCE DILATION.
 Vision therapy

- ADMINISTERED BY A TRAINED OPTOMETRIST HAS

SHOWN A SUCCESS RATE OF OVER 70%.

- TODAY THE ACCOMMODATION SPASM CAN BE TREATED,

ON TOP OF EYE DROPS DILATING PUPIL AND EYE
EXERCISE, USING SPECIAL COMPUTER GAMES
DECREASING VISUAL STRAIN AND VARIOUS TYPES OF
LASER, MAGNETIC AND ELECTRIC STIMULATION.
 Surgery

MULTIFOCAL INTRAOCULAR LENS IMPLANTATION IS A

NEW POSSIBLE TREATMENT INVOLVING CLEAR LENS
EXTRACTION AND MULTIFOCAL INTRAOCULAR LENS
IMPLANTATION BUT IT MAY NOT BE APPROPRIATE FOR
PATIENTS WHO HAVE HAD RESISTANT SPASM OF
ACCOMMODATION FOR A LONG PERIOD OF TIME.
 Prognosis

FOR ROUTINE CASES OF SPASM OF ACCOMMODATION,

THE AMERICAN OPTOMETRIC ASSOCIATION SAYS THE
PROGNOSIS IS FAIR AND ON AVERAGE, THE NUMBER OF
VISITS A PATIENT NEEDS WILL BE 1-2 FOR EVALUATION
AND 10 FOLLOW UP VISITS. ADDITIONALLY, THE AOA
RECOMMENDS THE FOLLOWING MANAGEMENT PLAN FOR
SPASM OF ACCOMMODATION: "BEGIN WITH PLUS
LENSES AND VT; IF VT FAILS, USE CYCLOPLEGIC AGENT
TEMPORARILY; EDUCATE PATIENT”.
 Cont.

FOR MORE CHRONIC AND ACUTE CASES THAT DO

NOT RESPOND TO VISION TRAINING AND
CYCLOPLEGIC DROPS, THE EYE MUSCLES
SHOULD WEAKEN WITH ADVANCING AGE
PROVIDING INTERMITTENT OR PERMANENT
RELIEF FROM THIS CONDITION.
Thank You