Hubbry Logo
Spasm of accommodationSpasm of accommodationMain
Open search
Spasm of accommodation
Community hub
Spasm of accommodation
logo
7 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Spasm of accommodation
Spasm of accommodation
Spasm of accommodation
View on Wikipedia
from Wikipedia

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. 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. This may cause pseudomyopia or latent hyperopia.

Although antimuscarinic drops (homatropine 5%) can be applied topically to relax the muscle, this leaves the individual without any accommodation and, depending on refractive error, unable to see well at near distances. Also, excessive pupil dilation may occur as an unwanted side effect. This dilation may pose a problem since a larger pupil is less efficient at focusing light (see pupil, aperture, and optical aberration for more.)

Patients who have accommodative spasm may benefit from being given glasses or contacts that account for the problem or by using vision therapy techniques to regain control of the accommodative system.

Possible clinical findings include:

Treatments

[edit]

Cycloplegic Eye Drops (Dilation)

[edit]

Spasm of accommodation is frequently resistant to treatment. However, some patients do find relief through the use of daily eye dilation with cycloplegic drops. One side effect of cycloplegic drops is that 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. 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. In addition, 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.[1]

In fact, none of the cycloplegic drops used to treat Spasm of Accommodation in the United States are available without BAK. This unfortunately makes treatment much more difficult as the side effect of dry eyes and corneal damage can occur. France, Australia, Canada, and the United Kingdom do have limited availability of BAK-free eye drops available in unidose, and they must be imported to the United States with a physician's letter to the FDA[2] enclosed with the imported prescription.

Due to the high potential of tear shield damage with long-term use and the associated dry eye condition caused by cycloplegic eye drops with BAK (preservative), many physicians do not recommend cycloplegic eye drops. In difficult cases, "cycloplegic agents are highly favored to break spasm quickly and may be more economical compared to other conventional therapies"[3]

Cyclopentolate, Atropine, Tropicamide, and Homatropine are the typical cycloplegic eye drops used once daily to treat spasm of accommodation by relaxing the ciliary muscle. One side effect is blurred vision since these induce dilation.

Vision Training

[edit]

Vision therapy administered by a trained optometrist has shown a success rate of over 70%.[4]

Surgery

[edit]

Multifocal intraocular lens implantation is a new possible treatment involving clear lens extraction and multifocal intraocular lens implantation[5] but it may not be appropriate for patients who have had resistant spasm of accommodation for a long period of time.

Research

[edit]

Experimental Nitroglycerin and Nitric Oxide

[edit]

Animal studies[6][7] have found nitroglycerin, a vasodilator used to treat angina, relaxes the ciliary muscle and may hold hope for those suffering from spasm of accommodation. Nitroglycerin is currently being investigated as a treatment for glaucoma, and has shown to decrease intraocular pressure and relax the ciliary muscle. According to Investigative Ophthalmology & Visual Science Journal. "In a nonhuman primate study, topical administration of nitroglycerin at a dose of 0.1% significantly decreased IOP in normotensive animals after 90 minutes".[7] Further, according to Wiederholt, Sturm, and Lepple-Wienhues,[8] "The data indicate (indicates [sic]) that an increase of intracellular cGMP by application of cGMP and organic nitrate or non-nitrate vasodilators induces relaxation of the bovine trabecular meshwork and ciliary muscle".

Experimental Perilla frutescens

[edit]

Since spasm of accommodation is a result of contraction of the ciliary muscle, the goal would be to relax the ciliary muscle. New studies conducted on rats using perilla frutescens aqueous extract have shown to relax the ciliary muscle. Since there are no known drugs to treat this eye condition, perilla frutescens in an aqueous extract form may result in the relaxation of the ciliary muscle in humans as well. Perilla frutescens is currently used in traditional medicine in Korea, Japan, and China and a clinical study "showed that PFA (perilla frutescens extract) attenuates eye fatigue by improving visual accommodation"[9]

Prognosis

[edit]

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.[10] 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".[This quote needs a citation]

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.[11]

See also

[edit]

References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Spasm of accommodation

View on Grokipedia
from Grokipedia
Spasm of accommodation, also referred to as accommodative spasm or accommodative excess, is an ocular condition in which the of the eye undergoes prolonged or excessive contraction, preventing proper relaxation and leading to at distance while near vision may remain intact or intermittently affected. This results in pseudomyopia, where the eye's focusing mechanism mimics nearsightedness without an actual . The condition primarily affects children and young adults, with prevalence rates varying from 2.8% in schoolchildren to 10.8% in university students, often linked to modern lifestyles involving prolonged near work. Common causes include extended periods of close visual tasks such as reading or screen use, emotional stress, anxiety, head trauma, uncorrected refractive errors like hyperopia or , and occasionally pharmacological influences such as parasympathetic stimulants. In some cases, it arises from underlying or poor lighting conditions that exacerbate accommodative demand. Symptoms typically manifest as intermittent for both near and distant objects, frontal or brow headaches, (asthenopia), fatigue after visual tasks, , and difficulty maintaining focus, which can interfere with daily activities like studying or driving. More severe presentations may include (inward eye deviation), (double vision), or (pupil constriction) due to associated near reflex involvement. Diagnosis involves a comprehensive , including testing, cycloplegic to differentiate from true , assessment of accommodative amplitude and facility, and dynamic to detect lead of accommodation. Tools like the near point of convergence test help rule out related vergence issues. Treatment strategies focus on breaking the spasm and addressing underlying factors, often starting with cycloplegic such as atropine or to paralyze the temporarily, followed by appropriate spectacle correction based on post-cycloplegic . , including accommodative rock exercises or flipper lenses, proves effective for rehabilitation, while plus lenses or aid in reducing near-work strain; in stress-related cases, relaxation techniques may suffice. Most episodes resolve spontaneously or with conservative management, though recurrent cases require ongoing monitoring to prevent chronic pseudomyopia.

Overview

Definition

Spasm of accommodation is an ocular condition defined as the sustained or excessive contraction of the , which prevents proper relaxation after focusing on near objects, resulting in pseudomyopia. This leads to blurred distance vision due to the lens remaining overly convex, while near vision stays clear as the muscle maintains its contracted state. In the normal process of accommodation, the , innervated by parasympathetic fibers from the (cranial nerve III), contracts to reduce tension on the zonular fibers, allowing the crystalline lens to thicken and increase its refractive power for sharp near vision. For distance vision, the relaxes, permitting the zonules to pull the lens into a flatter shape, thereby reducing its refractive power and enabling clear focus on distant objects. This condition, also referred to as accommodative spasm or accommodative excess, was first described in 1856 by German ophthalmologist Albrecht von Graefe as a form of dysfunction. Unlike true , which arises from permanent anatomical alterations such as axial elongation of the eyeball or excessive corneal curvature, spasm of accommodation is a transient, without structural changes, often resolvable through interventions that promote muscle relaxation.

Pathophysiology

Spasm of accommodation arises from a sustained contraction of the , a within the anterior of the eye responsible for adjusting the lens shape during focusing. In normal accommodation, parasympathetic stimulation causes the to contract, relaxing the tension on the zonular fibers attached to the lens equator; this allows the elastic lens capsule to assume a more spherical form, increasing its refractive power for near vision. However, in spasm of accommodation, this contraction persists inappropriately, preventing the zonular fibers from reasserting tension and thus inhibiting lens flattening required for distant vision. This results in a persistent hyperopic shift reversal, manifesting as pseudomyopia where the eye's focal point is shifted forward. The neural basis involves overstimulation of the , primarily through the (cranial nerve III), which innervates the via postganglionic fibers from the . release at the neuromuscular junctions of the triggers this excessive contraction, often without adequate counterbalance from sympathetic innervation that typically promotes muscle relaxation. This imbalance can stem from prolonged near-work demands or other triggers that heighten parasympathetic activity via the Edinger-Westphal nucleus, leading to a in the normal disengagement of the . Associated ocular changes frequently include , or , due to concurrent parasympathetic of the pupillae muscle, and convergence excess arising from the tightly coupled accommodation-convergence reflex. This reflex, which normally coordinates eye inward movement with lens accommodation, becomes exaggerated, potentially leading to or inward eye deviation. These alterations contribute to the overall dysfunction but are secondary to the primary ciliary spasm. The impact on visual acuity is characterized by an induced myopic shift, typically mimicking -1 to -3 diopters of refractive error, as the over-accommodated lens prevents clear distant focus while near vision may remain relatively unaffected or strained. This pseudomyopia is reversible upon cycloplegia, where agents like atropine block muscarinic receptors to induce ciliary muscle paralysis and restore lens relaxation.

Etiology

Causes

Spasm of accommodation is commonly triggered by prolonged near work, such as extended periods of reading, writing, or using digital screens, which leads to fatigue and sustained contraction of the . This excessive accommodative demand is particularly evident in individuals engaging in intense visual tasks without adequate breaks, resulting in overstimulation of the . Neurological and psychological factors also play a significant role, with emotional stress, anxiety, or precipitating episodes through parasympathetic overdrive and disruption of normal accommodative control. , including closed head trauma, can induce spasms by altering neural regulation of the . Ocular associations include , which contributes to accommodative imbalance, and uncorrected hyperopia, where the eye's reliance on constant accommodation for clear vision exacerbates the condition. Systemic links are rarer but encompass neurological disorders such as or intracranial masses that interfere with accommodative pathways, as well as certain medications like topical parasympathomimetics (e.g., ) that enhance ciliary muscle tone. Onset is typically acute, occurring shortly after periods of intense near visual tasks, and the condition is more prevalent in children and young adults due to their higher baseline accommodative and frequent exposure to near work demands.

Risk Factors

Spasm of accommodation primarily affects children between the ages of 6 and 15 years, as well as young adults, often in the context of refractive anomalies such as hypermetropia or . It shows a higher in females, potentially linked to greater susceptibility to anxiety disorders that influence ocular muscle function. Environmental factors significantly contribute to susceptibility, including excessive use of digital devices like smartphones, which can induce overstimulation during prolonged near work. Poor conditions during sustained close tasks further elevate risk, particularly in occupations or activities demanding extended focus, such as studying or artistic endeavors. Comorbid conditions heighten vulnerability, including pre-existing hyperopia or that strains accommodative mechanisms. Psychological stressors, notably anxiety disorders, are strongly associated, as they can exacerbate parasympathetic overactivity leading to accommodative spasms. A family history of accommodative disorders may also play a role, as evidenced by reported cases in siblings. Protective measures can mitigate risk, such as adhering to the 20-20-20 rule—taking a 20-second break every 20 minutes to view an object 20 feet away—to relax the accommodative system and prevent strain from digital exposure. Increased outdoor time and exposure to serve as additional safeguards by reducing overall near-work demands and supporting healthy ocular development.

Clinical Presentation

Symptoms

Patients with spasm of accommodation commonly experience for distant objects, while near vision remains relatively clear. This results in pseudomyopia, an apparent nearsightedness that fluctuates with fatigue or prolonged near tasks. Intermittent blurring at near distances can also occur after extended close work. Ocular discomfort frequently includes (asthenopia), frontal or orbital headaches, , and difficulty shifting focus between near and far objects. These symptoms often lead to reduced endurance for reading or sustained visual tasks, affecting or work performance, and may rarely involve if convergence mechanisms are affected. Complaints typically worsen in the evenings or following intensive near activities and can vary in intensity, persisting for days to months without intervention.

Signs

During clinical examination, spasm of accommodation presents with distinct objective findings, particularly in and motility assessments. Non-cycloplegic typically reveals apparent due to sustained contraction, with spherical equivalent values often in the range of -1.5 to -2.5 diopters, which shifts toward or hyperopia (e.g., +1.0 to +1.5 diopters) following cycloplegic agents like , confirming the functional nature of the . Dynamic at near demonstrates a lead of accommodation (negative lag, often ≤0 diopters), reflecting over-accommodation rather than the expected slight lag, distinguishing it from under-accommodation disorders. Ocular motility evaluation shows excessive convergence, often manifesting as esophoria greater than 2 prism diopters at near or intermittent , alongside with sizes reduced to 2-3 mm even in moderate illumination. Associated signs include phorias or tropias linked to the of the near , with esophoria at distance or near exceeding exophoric tendencies, while fundus examination remains normal, showing no organic pathology such as retinal or optic nerve abnormalities to rule out alternative causes. Severity is gauged through amplitude testing, where the push-up test often reveals an abnormally close near point (e.g., <5 cm, corresponding to amplitudes >20 diopters), highlighting the locked accommodative state, though facility flips (±2.00 diopters) fail after few cycles due to fatigue.

Diagnosis

History and Physical Examination

The diagnosis of spasm of accommodation begins with a thorough patient history to identify potential triggers and patterns of symptom onset. Clinicians inquire about recent increases in near work, such as prolonged reading, screen use, or other visually demanding tasks, which may precipitate the condition due to sustained ciliary muscle contraction. Patients often report associated symptoms including frontal or occipital headaches, ocular fatigue or asthenopia, and blurred vision particularly at distance following extended near focus; additional questions explore the duration of visual tasks, emotional stress as a contributing factor, and the timeline of onset—whether gradual and habitual or acute and stress-related. Family history of refractive errors or accommodative dysfunction is also elicited to assess genetic predispositions. On , is assessed at both distance and near, often revealing reduced distance acuity with preserved or hyperaccommodative near vision, reflecting the pseudomyopic shift from ciliary spasm. The cover-uncover test evaluates ocular alignment, potentially disclosing intermittent due to associated convergence excess, while pupillary examination typically shows from heightened parasympathetic activity. These findings help distinguish accommodative spasm from true refractive errors or . Differential diagnosis during history and exam considers chronic habits like excessive near work versus acute triggers such as trauma or , with bilateral presentation more suggestive of functional causes and unilateral involvement raising concern for underlying pathology. Red flags include sudden onset, unilateral symptoms, or neurological signs like unresponsive to basic alignment tests, warranting prompt to exclude intracranial lesions or cranial nerve involvement.

Confirmatory Tests

Confirmatory tests for spasm of accommodation involve objective assessments to verify sustained ciliary muscle contraction and differentiate it from true refractive errors or other ocular pathologies. These procedures build on initial findings, such as apparent myopia during non-cycloplegic refraction, by inducing temporary relaxation of accommodation or quantifying its dynamics. The cornerstone of diagnosis is cycloplegic refraction, which employs mydriatic-cycloplegic agents to paralyze the ciliary muscle and reveal the underlying refractive status. Agents like cyclopentolate hydrochloride (1%, 0.5%, or 0.1%) are instilled, typically one to two drops per eye, with refraction performed 30-45 minutes later to allow full cycloplegia. In cases of spasm, this test demonstrates resolution of pseudomyopia, often shifting from high myopia (e.g., -3.00 D or more) to emmetropia or hyperopia, confirming the accommodative origin. Atropine sulfate (1%) may be used for more profound cycloplegia in persistent or bilateral cases, though it requires longer recovery (up to 7-14 days). This procedure is essential, as manifest refraction alone can overestimate myopia due to the spasm. Accommodative testing further quantifies the dysfunction by evaluating the speed and amplitude of focusing responses. Accommodative facility is assessed using ±2.00 D flipper lenses, where the patient alternates fixation between a near target (e.g., 40 cm) and while the lenses are flipped; in spasm of accommodation, low gain is evident, with cycles per minute below age-expected norms (e.g., <10 cycles/min in adults) due to impaired relaxation. Amplitude of accommodation is measured via the push-up test, advancing a near target (e.g., ) toward the patient until blur occurs, yielding a lead of accommodation that may appear normal or elevated in spasm but fails to relax fully on fixation. These dynamic tests highlight the tonic contraction characteristic of the condition, distinguishing it from accommodative insufficiency. Vergence assessment evaluates associated convergence abnormalities, as spasm of accommodation often coexists with convergence excess. The accommodative convergence/accommodation (AC/A) ratio is calculated using the gradient method: deviation is measured at distance (6 m) and near (40 cm or 33 cm), with the difference divided by the accommodative demand (e.g., 2.50 D for 40 cm); ratios exceeding 5:1 prism diopters per diopter suggest accommodative-driven convergence spasm. of convergence testing, using a penlight or target advanced slowly, may reveal a break point closer than 6 cm, indicating spasm-related esophoria. These measures help exclude primary vergence disorders. Imaging modalities, such as (OCT) or ultrasound biomicroscopy, are rarely indicated but may be employed to rule out structural anomalies mimicking spasm, like anterior segment inflammation or lens subluxation. can visualize thickness or anterior chamber dynamics during attempted relaxation, while ultrasound assesses zonular integrity if trauma is suspected. Their use is reserved for atypical presentations unresponsive to .

Management

Pharmacological Interventions

The primary pharmacological approach to managing spasm of accommodation involves , which paralyze the to interrupt the sustained contraction and restore normal accommodative function. These anticholinergic drugs block muscarinic receptors, inducing both and , thereby alleviating pseudomyopia and associated visual disturbances. Atropine, a potent and long-acting cycloplegic, is indicated for severe or persistent cases, providing complete relaxation of accommodation for up to 7-10 days after instillation. It is typically administered as 1% ophthalmic drops twice daily for 3-7 days initially, with extension to 1-2 weeks in refractory spasms under close supervision to ensure symptom resolution. For milder or acute episodes, shorter-acting agents like cyclopentolate 1% or tropicamide 1% are preferred; these are instilled twice at 5-minute intervals, offering cycloplegia for 6-24 hours and allowing quicker recovery of near vision. Both cyclopentolate and atropine demonstrate comparable efficacy in achieving full cycloplegia, with studies reporting significant hyperopic shifts of 3-3.5 diopters and no symptom recurrence at 3-month follow-up in treated patients. The mydriatic properties of these agents also provide symptomatic relief from photophobia by dilating the pupil and reducing light sensitivity. For accompanying headaches, oral analgesics such as ibuprofen may be recommended to manage discomfort, particularly in cases linked to prolonged near work or stress. Monitoring is essential due to potential side effects, including transient blurred near vision, dry mouth, and ocular discomfort from cycloplegia and mydriasis. Atropine carries a higher risk of systemic effects such as tachycardia, confusion, or hallucinations, especially in children or with overuse. Contraindications include narrow-angle glaucoma, where these agents can precipitate acute angle closure due to pupillary dilation and potential intraocular pressure elevation. Patients with primary open-angle glaucoma require cautious use, with intraocular pressure checked prior to initiation.

Non-Pharmacological Interventions

Non-pharmacological interventions for spasm of accommodation focus on training the to relax, reducing visual demands, and addressing contributing environmental factors to alleviate symptoms and prevent recurrence. , often delivered through orthoptic exercises, targets accommodative facility by improving the eye's ability to shift focus between near and far objects, thereby promoting ciliary muscle relaxation. Common techniques include the Brock string, which enhances vergence and accommodative coordination by having patients focus on beads along a string to train binocular alignment and , and lens flippers, typically using +2.00 D and -2.00 D lenses alternated to build speed in accommodative responses, aiming for at least 11 cycles per minute without fatigue. These exercises are particularly effective in restoring normal accommodative amplitude and facility, with studies showing significant improvements in children after structured programs. Optical aids play a key role in minimizing accommodative effort during near tasks, which can exacerbate spasms. Bifocal or progressive addition lenses reduce the demand on the by providing additional plus power for reading, allowing clearer near vision without excessive focusing. Plus lenses specifically for near work, such as +1.00 to +2.00 D reading glasses, further relax accommodation and are often prescribed as an initial intervention to break the cycle. These aids are tailored based on cycloplegic to ensure accurate correction and symptom relief. Lifestyle modifications emphasize visual hygiene and stress reduction to mitigate triggers like prolonged near work and tension, which can sustain ciliary spasms. The 20-20-20 rule—every 20 minutes, looking at an object 20 feet away for 20 seconds—helps relax the accommodative system and reduce from screens. Ergonomic adjustments, such as maintaining a 25-inch viewing distance, optimizing lighting to avoid glare, and ensuring proper posture during desk work, further decrease visual stress. Stress management techniques, including relaxation exercises like (covering closed eyes with palms to block light and promote muscle rest), address emotional factors that may contribute to spasms. Therapy sessions are typically conducted 2-3 times weekly for 3-6 months, often combining in-office visits with home reinforcement, leading to high success rates in children where up to 91% achieve normalized accommodative amplitude and 87% improve facility.

Research Directions

Pharmacological Investigations

Investigations into the (NO) pathways have explored the use of NO donors, such as , to promote relaxation in spasm of accommodation. Similar experiments using bovine have shown that NO donors counteract contractions induced by carbachol and , potentially shortening spasm duration through enhanced NO signaling and cyclic GMP production. These findings suggest NO donors could serve as adjuncts to traditional cycloplegics by targeting alternative relaxation mechanisms, though human trials remain pending due to concerns over systemic . Research on parasympathetic modulation has investigated alpha-agonists and beta-blockers as potential alternatives to direct anticholinergics like agonists, which exacerbate . In rhesus monkey studies, non-selective beta-blockers such as timolol modulated accommodative responses under open- and closed-loop conditions without inducing ciliary , indicating a possible inhibitory role on excessive parasympathetic drive. Despite these advances, pharmacological research faces challenges, including a scarcity of large-scale randomized controlled trials (RCTs) owing to the condition's typically benign and self-resolving nature. The rarity of persistent cases complicates recruitment, and ethical concerns over long-term in children further hinder robust endpoints like spasm recurrence rates.

Alternative Therapies

Research into alternative therapies for spasm of accommodation has explored various non-conventional approaches, including herbal extracts, , practices, and nutraceuticals, primarily targeting symptom relief through anti-inflammatory, relaxant, or stress-reducing mechanisms. These interventions aim to alleviate ciliary muscle tension and associated pseudomyopia, often in the context of eye fatigue from prolonged near work or stress. Studies on herbal extracts, particularly var. acuta, have demonstrated potential anti-inflammatory and muscle-relaxant effects on ocular structures. and experiments showed that aqueous extracts of P. frutescens relax ciliary by increasing (NO) and (cGMP) levels, thereby inhibiting 5A (PDE5A) activity and promoting muscle relaxation relevant to accommodative spasms. A small involving oral supplementation of 300 mg/day P. frutescens extract for four weeks in participants with visual display terminal-induced eye fatigue reported significant improvements in accommodative amplitude and reduction in symptoms like and , suggesting symptom relief through enhanced visual accommodation. These findings from 2017-2018 trials indicate preliminary benefits, though larger-scale validation is required. Pilot studies on acupuncture and mindfulness have linked these practices to stress reduction and decreased spasm incidence, particularly in Asian populations where traditional methods are prevalent. A retrospective analysis of auricular acupressure combined with acupuncture in 120 children with juvenile pseudomyopia (often resulting from accommodative spasm) showed significant improvements in refractive error and accommodative function after eight weeks, with no adverse effects reported. Systematic reviews of acupuncture for pseudomyopia further support its efficacy in relaxing ocular muscles and improving visual acuity, drawing from multiple Asian cohort studies. Similarly, mindfulness-based interventions, such as yogic eye exercises and trataka (gazing meditation), have been evaluated in small trials among undergraduate students in Asian settings; a pre-post study of trataka kriya in individuals with digital eye strain demonstrated reduced ocular fatigue scores and enhanced focusing ability after regular practice, attributing benefits to lowered stress and improved mindfulness. Another pilot on mindful relaxation combined with eye yoga reported decreased symptoms of eye strain in computer users, linking stress mitigation to better accommodative stability. Nutraceuticals like omega-3 fatty acids and have shown adjunctive benefits in preventing ocular associated with accommodative issues. Meta-analyses indicate that omega-3 supplementation reduces and dry eye symptoms in digital eye strain, potentially easing overload. Combined / and omega-3 intake in randomized trials improved accommodative response and reduced in adults with prolonged screen exposure, with one review highlighting moderate evidence for symptom alleviation in . These effects are thought to stem from protection of and ciliary tissues. Despite promising results, most evidence for these alternative therapies derives from small-sample pilot studies or anecdotal reports, limiting generalizability. For instance, herbal and nutraceutical trials often involve fewer than 100 participants, while acupuncture and mindfulness studies lack large randomized controls. Standardization of extracts, protocols, and outcome measures remains a critical need to establish efficacy and safety for spasm of accommodation.

Prognosis and Complications

Prognosis

The prognosis for spasm of accommodation is generally favorable with prompt and appropriate , with high success rates in treated cases. Full resolution typically occurs within weeks for acute episodes following cycloplegic or optical interventions, while chronic cases may require months of to achieve normalization of accommodative function. In one study of patients undergoing , 87% eliminated associated asthenopic symptoms and normalized findings after approximately 26 sessions. Age significantly influences outcomes, with children experiencing better prognosis due to the often self-limiting nature of the condition, which tends to resolve spontaneously by as accommodative demands stabilize. In contrast, adults may face more persistent symptoms, particularly when linked to ongoing stressors or prolonged near work, necessitating sustained interventions to prevent chronicity. The risk of recurrence is low when lifestyle modifications—such as reducing near-work duration and managing stress—are implemented alongside treatment. However, uncorrected refractive errors, such as hypermetropia, can increase relapse risk by exacerbating accommodative strain. In long-term follow-up of treated patients, post-therapy effects persisted without regression for at least one year in the majority. Follow-up care is essential for at-risk groups, including children with a history of the condition or adults under high visual stress; annual optometric examinations are recommended to monitor accommodative stability and detect early signs of relapse. More frequent monitoring, every 3-6 months, may be advised initially for spectacle-dependent patients.

Complications

Untreated spasm of accommodation can result in chronic pseudomyopia, where persistent contraction leads to sustained blurred distance vision and refractive shifts of several diopters. In children, bilateral chronic pseudomyopia may occur if untreated, particularly when associated with secondary . Untreated pseudomyopia may progress to true in children, with one 2023 study reporting a 21.2% conversion rate within six months. Prolonged accommodative strain from the spasm often causes chronic asthenopia, manifesting as ongoing eye fatigue, discomfort, and reduced visual endurance during near tasks. The visual instability induced by spasm of accommodation frequently heightens anxiety, as fluctuating blur disrupts daily activities and creates uncertainty about vision reliability. In school-aged children, this can lead to or diminished academic performance due to difficulties with reading and close work, exacerbating emotional distress. Ocular complications include rare secondary , where excess convergence accompanies the accommodative spasm, potentially limiting eye abduction and causing . Treatment with cycloplegic drops, such as tropicamide or atropine, may provoke allergic reactions including periorbital swelling, itching, and conjunctival hyperemia in susceptible individuals. Systemic associations involve exacerbation of , as the condition's onset or persistence is often triggered by emotional distress, creating a feedback loop that intensifies anxiety or . Additionally, the associated headaches from ciliary strain can worsen underlying patterns in predisposed patients.

References

  1. https://www.ncbi.nlm.nih.gov/books/NBK592379/
  2. https://pubmed.ncbi.nlm.nih.gov/36384286/
  3. https://www.texaschildrens.org/content/conditions/accommodative-spasm
  4. https://pubmed.ncbi.nlm.nih.gov/24605432/
  5. https://www.ncbi.nlm.nih.gov/books/NBK542189/
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC7383162/
  7. https://www.myopiaprofile.com/articles/what-is-pseudomyopia
  8. https://www.sciencedirect.com/topics/neuroscience/ciliary-muscle
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC8459808/
  10. https://pubmed.ncbi.nlm.nih.gov/11937900/
  11. https://pmc.ncbi.nlm.nih.gov/articles/PMC8377937/
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC6844508/
  13. https://www.aoa.org/AOA/Documents/Practice%20Management/Clinical%20Guidelines/Consensus-based%20guidelines/Care%20of%20Patient%20with%20Accommodative%20and%20Vergence%20Dysfunction.pdf
  14. https://pmc.ncbi.nlm.nih.gov/articles/PMC2907036/
  15. https://eyewiki.aao.org/Computer_Vision_Syndrome_%28Digital_Eye_Strain%29
  16. https://pmc.ncbi.nlm.nih.gov/articles/PMC7640876/
  17. https://www.longdom.org/open-access/treatment-approaches-of-accommodative-spasm-a-minireview-97389.html
  18. https://pjmhsonline.com/2022/jan/888.pdf
  19. https://www.ovpjournal.org/uploads/2/3/8/9/23898265/ovp6-5_article_satgunam_web.pdf
  20. https://eyewiki.org/Spasm_of_the_Near_Synkinetic_Reflex
  21. https://www.researchgate.net/publication/358897664_Diagnosis_and_Treatment_of_Accommodative_Spasm_with_Cycloplegics
  22. https://journals.lww.com/tnoa/fulltext/2017/55040/accommodative_spasm__case_series.9.aspx
  23. https://reviewofmm.com/case-study-pseudomyopia/
  24. https://www.myopiaprofile.com/articles/measuring-accommodative-facility
  25. https://pmc.ncbi.nlm.nih.gov/articles/PMC7425728/
  26. https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-022-02557-x
  27. https://pubmed.ncbi.nlm.nih.gov/39967914/
  28. https://www.sciencedirect.com/topics/medicine-and-dentistry/cycloplegia
  29. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/cycloplegic-agent
  30. https://www.dovepress.com/cycloplegia-in-children-an-optometristrsquos-perspective-peer-reviewed-fulltext-article-OPTO
  31. https://www.optometrytimes.com/view/all-about-red-caps-mydriatics-and-cycloplegics
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC3204163/
  33. https://www.aao.org/eye-health/tips-prevention/computer-usage
  34. https://pubmed.ncbi.nlm.nih.gov/9426959/
  35. https://www.researchgate.net/publication/12012826_Effects_of_Nitric_Oxide_Donors_and_Nitric_Oxide_Synthase_Substrates_on_Ciliary_Muscle_Contracted_by_Carbachol_and_Endothelin_for_Possible_Use_in_Myopia_Prevention
  36. https://pmc.ncbi.nlm.nih.gov/articles/PMC3637388/
  37. https://pmc.ncbi.nlm.nih.gov/articles/PMC6100439/
  38. https://pubs.sciepub.com/jfnr/5/8/4/index.html
  39. https://pmc.ncbi.nlm.nih.gov/articles/PMC10508539/
  40. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0041-1732811
  41. https://www.sciencedirect.com/science/article/pii/S016164202200361X
  42. https://pmc.ncbi.nlm.nih.gov/articles/PMC4997915/
  43. https://www.reviewofoptometry.com/article/accommodation-in-peril
  44. https://morancore.utah.edu/section-05-neuro-ophthalmology/convergence-spasm-patient-education/
  45. https://pmc.ncbi.nlm.nih.gov/articles/PMC5123123/
  46. https://www.reviewofoptometry.com/news/article/should-accommodative-spasm-in-kids-be-cause-for-concern
  47. https://eyewiki.org/Asthenopia
  48. https://pmc.ncbi.nlm.nih.gov/articles/PMC11082526/
  49. https://www.sciencedirect.com/science/article/abs/pii/S107190912100053X
Add your contribution
Related Hubs
User Avatar
No comments yet.