Diagnosis and Treatment of Accommodative Spasm with Cycloplegics

Abstract

Purpose: To evaluate the role of cycloplegic agents in diagnosis and management of accommodative spasms. Methods: Prospective cohort study included patients with recent onset ocular strain. All patients underwent comprehensive eye examination and objective refraction. Then patients were randomized to receive either atropine or cyclopentolate for cycloplegia. And objective refraction was recorded again. Patients were randomly assigned to one of the two treatments i.e.full cycloplegic correction or 0.001% atropine and reviewed at 1-, 2- and 3-month follow-ups. Results: Total 52 patients, mean age16.1±4.7 were evaluated. 33 patients (63.5%) received atropine and 19 (36.5%) received cyclopentolate. There was significant difference between precycloplegic and post cycloplegic refraction however, the difference between cyclopentolate and atropine was not significant. None of the patients, whether treated with glasses or low dose atropine experienced any ocular strain till the end of study. Conclusion: Both cyclopentolate and atropine are equally effective in achieving adequate cycloplegia in patients with accommodative spasm. Plus corrective wear or low dose atropine are equally effective in relieving the symptoms of patients. Keywords: Cycloplegic agents, Post-cycloplegic refraction, Accommodative spasm

Accommodative spasm and its different treatment approaches: A systematic review

“…6 An accommodative spasm may manifest as a spasm of the near reflex or pseudomyopia. 4 Large exophoria, intermittent divergent squint, 19 and the sudden onset of esotropia 22 frequently result in blurred distance and near vision in both eyes. Rutstein and Totle, London et al, Hughes et al, and Peinado et al report one-sided blurring of vision in one eye that disrupts binocular vision.…”

“…Clinically, an accommodative spasm is also known as pseudomyopia, a near reflex spasm, or hyper-accommodation. 4…”

“…Neurological disorders, head trauma, meningitis, pituitary tumours, photosensitive epilepsy, stroke, and ocular and systemic drugs are all rare associated conditions. 4…”

“…Clinically, an accommodative spasm is also known as pseudomyopia, a near reflex spasm, or hyper-accommodation. 4 Spasm of the near reflex is a severe form of accommodative spasm marked by intermittent accommodation, convergence, miosis, unilateral and bilateral abduction limitations, and high manifest myopia. 5 Most of the time, cycloplegic eye drops can correct manifest myopia, a condition known as pseudomyopia.…”

“…Neurological disorders, head trauma, meningitis, pituitary tumours, photosensitive epilepsy, stroke, and ocular and systemic drugs are all rare associated conditions. 4 This review alternately engages the terms accommodative spasm, pseudomyopia, and the spasm of the near reflex in an effort to examine the aetiology and various treatment methods.…”