BSV & Orthoptic techniques

Course code: OD-139

Hifza Imtiaz
Assistant Professor
The University Of Lahore
Anomalies of accommodation
Learning Objectives

Students will learn about

 Anomalies of accommodation
 Etiology of anomalies
 Clinical features
 Treatment
 Anomalies of accommodation
Contents
• Accommodation…….. Overview
• Anomalies of accommodation & classification
• Clinical presentation
• Management
• The human eye, with its various parts, plays a very important role in
our lives. It helps us see.
• This may seem simple enough to just say it like that, but a series of
operations occur from the point of light rays entering our eyes till we
perceive the image of whatever we are seeing.
• One of these processes is the Power of Accommodation of the eye.
Accommodation
• Accommodation is the process by which the vertebrate eye changes
optical power to maintain a clear image or focus on an object as its
distance varies.
• The process by which certain muscles (called ciliary muscles) function
to change the focal length of the eyes so that the image is clearly formed
on the retina is called accommodation of the eye.
• This will vary for near and distant objects and also for objects moving
away or towards the eye.
• By adjusting the focal length, the eye is actually changing its lens
power.
• This is called the accommodating power of the eye.
PARALYSIS OF ACCOMMODATION

• It refers to complete absence of

accommodation also known as cycloplegia
 CAUSES

• Drug induced cycloplegia results due to the

effect of parasympatholytics drugs such as
atropine, homatropine and others.
• Internal ophthalmoplegia means paralysis of
sphincter pupillea muscles and ciliary muscle
may result from neuritis associated with
diphtheria and syphilis, diabetes, chronic
alcoholism, cerebral or meningeal diseases
including even a mild head injury
• Paralysis of accommodation as component of
complete 3rd nerve paralysis may occur due to
intracranial or orbital causes. the lesion may be
traumatic, inflammatory or neoplastic
 CLINICAL FEATURES

• Blurring of near vision

• It is the main complaint in previously emmetropic or
hypermetropic patient. Blurring of vision may not be
marked in myopic patient
• Photophobia: It is due to accompanying mydriasis.
Usually associated with blurring of near vision.
• On examination there is abnormal receding of NPA
and markedly decreased range of accommodation
 TREATMENT

• Treat the systemic diseases such as diphtheria,

syphilis etc.
• Self recovery occur in drug induced paralysis.
• Dark glasses to reduce the glare
• In permanent paralysis plus lenses for near
vision.
INCREASED ACCOMMODATION

• EXCESSIVE ACCOMMODATION

• SPASM OF ACCOMMODATION
EXCESSIVE ACCOMMODATION

• It is a situation in which an individual exerts

more than normal accommodation for
performing certain near work.
• It is with in the voluntary control of the
individual and is an intermittent process.
 CAUSES

• Certain degree of excessive accommodation is

frequently noted under following circumstances
• Young hypermetropes frequently use
excessive accommodation as a physiological
adaptation to attain clear vision.
• Young myopes performing excessive near
work may also use excessive accommodation
in association with excessive convergence.
• Astigmatic errors in young persons may also
be occasionally with the use of excessive
accommodation.
• Presbyopes in the beginning also use excessive
accommodation to accomplish near work.
• Use of improper or ill-fitting spectacles may
also cause use of excessive accommodation
Precipitating factors

• Large amount of near work.

• Habitual near work in deficient or excessive
illumination.
• Physical or mental ill health
 CLINICAL FEATURES
• Blurred vision of varying degree due to
induced pseudomyopia
• Symptoms of accommodative asthenopia
• Both far point and near point are brought
nearer to the eye
• Near vision also suffers in the more marked
degrees and after reading for some time the
printed page becomes confused and clears up
only after a temporary rest.
 TREATMENT

• The treatment is usually effective with good

prognosis
• Optical treatment correct refractive error
while performing cycloplegic refraction
• General treatment near work should be
forbidden for a period
• General conditions of the patient’s health
should receive special attention
SPASM OF ACCOMMODATION

• Spasm of accommodation is a continuous

prolonged use of excessive accommodation or
it refers to the abnormally excessive
accommodation which is out of the voluntary
control of the individual.
 Causes

• Drug induced spasm of accommodation is

known to occur after use of strong miotics such
as echothiophate

• Spontaneous spasm of accommodation

Occasionally found in children usually in
uncorrected hypermetropes but also in astigmatic
and even in myope children.
 It usually occur when the eyes are used for
excessive near work in unfavorable conditions
such as bad illumination , bad reading position,
lowered vitality, state of neurosis, mental stress
and anxiety.
• Spasm of near reflex is a clinical
syndrome often seen in disturbed and
tense individuals who presents with

• Excessive accommodation
• Excessive convergence and
• Miosis
 Clinical features

• Varying blurred vision due to induced

pseudomyopia
• Asthenopic symptoms are more marked than
the visual symptoms (blurr).
• Headache and brow ache are typical features.
• NPA is abnormally close.
 TREATMENT
• Relaxation of ciliary muscles
• The most effective method of treatment is
the production of complete ciliary paralysis
with atropine .
• Optical treatment
correcting spectacle should be worn immediately
when eyes are used again after period of
cycloplegia.
• General treatment
• Near work should be forbidden for a period
• The general condition of the patient health
should receive special attention.
• Therefore, a holiday with a change of air
usually has a greater effect than anything else.
 References

• Borish’s clinical refraction

• Wikipedia
Learning outcomes

Students have learnt

 Anomalies of accommodation
 Clinical features & its etiology
 Management