Zeitschrift für klinische und experimentelle Ophthalmologie
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Treatment Approaches of Accommodative Spasm: A Mini-Review

Prithwis Manna, Puja Sarbajna, Sourav Karmakar

Accommodation is a process that allows a sharp focus on the fovea by relaxing the ciliary muscle, decreasing the lens's diameter, and increasing its thickness and curvature. The midbrain supranuclear impulse produces the motor command, leaves the Edinger Westphal nucleus and creates the near-triad synkinesis. An accommodative spasm occurs when the near triad reflexes fail. Common causes of accommodative spasms include excessive near work, psychological stress, head trauma, and strabismic and non-strabismic conditions. This review conducted a comprehensive analysis to comprehend the clinical characteristics, aetiology, diagnostic markers, and treatment alternatives. The most common symptoms of accommodative spasm include reduced distance and near vision, frontal headache, sensitivity to light or glare, and eyestrain during close work. In addition, the signs of accommodative spasm are a variation in visual acuity at a distance, a decreased retinoscopic reflex, and a smaller pupil. Despite its many limitations, cycloplegia is the primary method for accurately identifying the accommodative spasm. It includes increased intraocular pressure, blockage of the lacrimal duct, macular oedema, an allergic reaction, discomfort, and blurs vision. This mini-review focuses on non-invasive treatment alternatives, such as regular cycloplegic drugs, bifocals for near work, manifest prescription, the modified optical fogging approach, and vision therapy. The objective is to relax the accommodation and eradicate the symptoms associated with pseudomyopia.