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      Accommodative spasm in siblings: A unique finding

      case-report
      Author(s):
      Publication date (Print):
      Journal: Indian Journal of Ophthalmology
      Publisher: Medknow Publications
      Keywords: Accommodative spasm, pseudomyopia, siblings

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          Abstract

          Accommodative spasm is a rare condition occurring in children, adolescents, and young adults. A familial tendency for this binocular vision disorder has not been reported. I describe accommodative spasm occurring in a brother and sister. Both children presented on the same day with complaints of headaches and blurred vision. Treatment included cycloplegia drops and bifocals. Siblings of patients having accommodative spasm should receive a detailed eye exam with emphasis on recognition of accommodative spasm.

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          Accommodative dysfunction.

          K DAUM (1983)
          A retrospective review of the records of 114 subjects with accommodative dysfunction has been completed. Most subjects (N = 96) were found to have accommodative insufficiency. Lesser numbers of subjects were categorized in the class of infacility of accommodation (N = 14), spasm of accommodation (N = 3) and fatigue of accommodation (N = 1). A majority of the subjects presented with complaints of blur, headaches and/or asthenopia while attempting nearwork. Most subjects presented with reduced abilities in one or more of the following areas: accommodative amplitude and facility, fusional vergences, near point of convergence and stereo acuities. The clinical characteristics of the group as a whole and the major subgroups have been examined both before and after treatment of the condition with orthoptic exercises and/or plus lenses at the nearpoint. The result of the treatment indicates that although most subjects (96%) experienced some relief with treatment only about half (53%) had their problems totally solved. The importance of these findings is briefly discussed.
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            Accommodative spasm: a study of 17 cases.

            J Amos, Robert P Rutstein, Moritz M. Daum (1988)
            Accommodative spasm (AS) is rarely reported in the literature. We studied 17 patients with accommodative spasm. Most patients were clinically emmetropic. Ten patients also manifested a spasm of the near reflex (SNR). The probable etiology of the accommodative disorder for most patients was psychogenic as revealed by case histories and visual field analysis. Treatment consisted primarily of plus reading lenses and, in some instances, orthoptic training. Some patients also underwent psychological counseling. Follow-up ranged from 2 months to 30 months. Although visual symptoms improved for most patients, only four patients had complete resolution of the spasm.
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              Post-traumatic pseudomyopia.

              Nyall London, J. Wick, David Kirschen (2003)
              Many clinicians have noted that patients demonstrate a myopic refractive change following Traumatic Brain Injury (TBI). This apparent myopic shift disappears with cycloplegia, yet stubbornly reappears as soon as the pharmaceutical effect wears off. We propose that this shift is secondary to an irritative lesion that affects the parasympathetic innervation, resulting in ciliary body contracture. The dilemma for the clinician is whether to provide the immediate relief of clear distance vision by prescribing additional minus lenses, or to work toward attempting to re-establish the baseline refractive error. The natural history of post-traumatic pseudomyopia in our experience involves one of the following three courses: (1) a transient condition that will occasionally resolve; (2) the typical case, a recalcitrant condition that will resolve under cycloplegic intervention, but immediately return as the cycloplegic wears off; or (3) a less-common subgroup of patients who continue to show an increase in myopia over time. Our description of these cases demonstrates management strategies (including atropinization) to relax accommodative spasm, traditional vision therapy techniques aimed at loosening the accommodative system, and refractive corrections. Pseudomyopia is one of many ocular and behavioral sequelae following TBI. By understanding the natural course and potential management options for post-traumatic pseudomyopia, the clinician will be better prepared to deal with these challenging cases. Flexibility is required, since options that work with one patient may prove ineffective with another. Counseling the patient as to potential outcomes given the natural history of this condition helps establish more-realistic expectations by the patients being treated.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Medknow Publications (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): Jul-Aug 2010
                Volume: 58
                Issue: 4
                Pages: 326-327
                Affiliations
                School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama 35294-0010, USA
                Author notes
                Correspondence to: Prof. Robert P Rutstein, O.D., School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama 35294-0010, USA. E-mail: bagel@ 123456uab.edu
                Article
                Publisher ID: IJO-58-326
                DOI: 10.4103/0301-4738.64123
                PMC ID: 2907036
                PubMed ID: 20534925
                SO-VID: b3021596-6207-4e39-8c1a-aec519327d55
                Copyright © © Indian Journal of Ophthalmology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 November 2008
                Date accepted : 06 March 2009
                Categories
                Subject: Brief Communications

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: pseudomyopia,siblings,accommodative spasm
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: pseudomyopia, siblings, accommodative spasm

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