An accommodation spasm is defined as inadequate protracted contraction of the ciliary muscle.
Accommodation spasms arerare. They may occur asfunctionalimpairment or they may occur iatrogenically when treating young patientswith parasympathomimetic agents (miotic agents). The functional impair-ments are frequently attributable to heightened sensitivity of the accommo-dation center, which especially in children (often girls) can be psychogenic. Rarely the spasm is due to organic causes. In these cases, it is most oftenattributable 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.
Patients complain of deep eye pain and blurred distance vision(lenticular myopia).
The diagnosis ismade 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 accommoda-tive esotropia and accommodative pupil narrowing.
This depends on the underlying disorder. Cycloplegic therapywith agents such as tropicamide or cyclopentolate may be attempted in the presence of recurrent accommodation spasms.
Iatrogenic spasms are completely reversible by discontinuing theparasympathomimetic agents. The prognosis is also good for patients with functional causes. Spasms due to organic causes require treatment of the un-derlying disorder but once treatment is initiated the prognosis is usually good.