Relentless Bilateral Accommodation Spasm In An Adolescent Treated With Clear Lens Extraction: A Case Report

Pathologic accommodation spasm occurs when a persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report is to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years.

A 10-year-old female patient was initially observed due to complaints of decreased visual acuity and frequent headaches. Two years later, after several visits, the diagnosis of pseudomyopia due to accommodation spasm was established. The systemic study did not demonstrate any organic cause for the symptoms. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and the intolerance to its side effects demanded further action, so a clear lens extraction was carried out, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected visual acuity was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 add. The patient was satisfied, reported no dysphotopic phenomena, and had no other associated complications.

In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease, even when organic causes are not identified. In selected cases, surgery with intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.