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The curious case of accommodative spasm!

Poster Details

First Author: A.Kavthekar INDIA

Co Author(s):    S. Nishanth   N. Madhivanan   P. Nivean   N. Madhivanan           

Abstract Details

Purpose:

This study highlights the importance of cycloplegic refraction to detect accommodative spasm in case of pseudomyopic patients and role of atropinisation for its management.

Setting:

This retrospective study was done at M.N. Eye hospital, a tertiary care eye hospital in Chennai, India

Methods:

Four patients, presented with complaints of sudden onset blurring of distant vision and asthenopic symptoms.They gave history of aggravation of symptoms with prolonged near work and under stressful conditions. Their uncorrected visual acuity at presentation was getting corrected to 6/6 with a myopic correction.After cycloplegia,the autorefraction showed hypermetropic shift.Vision after cycloplegia was 6/6 for distance in all patients with their respective hyperopic correction,and N6 with upto �.00 dioptres.Diagnosis of accommodative spasm was made.Glasses with cycloplegic refraction was prescribed and atropinisation(1%) with avoidance of aggravating factors was started . Patients were tapered gradually with atropine to prevent recurrence.

Results:

Age of patients was between 11 to 12 (mean 11.5)years.Their myopic correction was between -7.00 to -0.25 (mean -3.625) spherical dioptres which shifted to hyperopia ranging from �.00 to �.50 (mean �.25) spherical dioptres.Post cycloplegia,all the 4 patients had improved to visual acuity of 6/6 for distance and N6 for near with hyperopic correction. Patients were improved in regards of asthenopic symptoms and visual acuity after cycloplegia and atropinisation (1%) twice a week.All our patients were tapered with atropine and followed up for a period of upto 6 months, during which none had recurrence.

Conclusions:

Patients with accommodative spasm present with pseudomyopia, miosis and frontal headaches,with stress being the most common triggering factor. Complete cycloplegic refraction,with atropinisation and prescription of progressive glasses are the mainstay of treatment. Slow weaning of atropine, with close follow-up can prevent recurrences.

Financial Disclosure:

NONE

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