20.04.2021

Accommodation spasm

Accommodation spasm (false myopia , tired eye syndrome) is a disorder of accommodation (distance accommodation) caused by a fixed tension of the ciliary muscle. Accommodation spasm is one of the most frequent diseases in pediatric ophthalmology , which ranks second after myopia.

According to statistics, 15% of school-age children suffer from accommodation spasm. Up to a certain point, accommodation spasm is reversible, but long-term uncorrected false myopia may eventually turn into true myopia in children .

Mechanism of accommodation spasm

Accommodation is a mechanism for focusing the gaze at different distances. Normally, this process is governed by the coordinated work of the accommodative apparatus, which includes three anatomically interrelated elements of the eye – the ciliary muscle, the zinnas ligaments and the crystalline lens. The ciliary (accommodative) muscle is represented by three main portions of the smooth muscle fibers: the meridional (Brückke muscle), the radial (Ivanov muscle) and the circular (Muller muscle).

During accommodation into the distance (deaccoding) the muscles are relaxed. When focusing on nearby objects, the meridional fibers of the ciliary muscle are strained, the contraction of Zinn ligaments is weakened, which is accompanied by an increase in the curvature of the lens and an increase in eye refraction. In case of accommodation spasm, the radial and circular fibers of the ciliary muscle, which are disaccommodative in their function, cannot fully relax. As a result, the ciliary body is in a state of persistent long contraction – accommodation spasm.

Finding the ciliary muscle in a state of constant tension is accompanied by a violation of its blood supply and is a risk – factor for the subsequent development of chorioretinal dystrophy .

Causes of accommodation spasm

Accommodation spasm in most cases develops in children, adolescents or young people, which is associated with the age features of the accommodative apparatus. The main reasons for school accommodation spasm in schoolchildren are excessive visual loads associated with watching TV for a long time, working at a computer monitor, improperly selected educational furniture, reading at close range, poor lighting, eye exposure to too bright light, etc. Besides, the development of a spasm of accommodation contributes to the irrational mode of the day of the child, in which insufficient time is given to sleep, walks in fresh air, physical activity and exercise for the eyes. Among the common causes, asthenia, hypovitaminosis, vertebrobasilar insufficiency,violations of posture, juvenile osteochondrosis.

With age, after about 40-45 years, the lens thickens and becomes less elastic, which is accompanied by a decrease in the ability to see good near vision, i.e. age-related weakening of accommodation – the development of age-sighted vision ( presbyopia ). Therefore, accommodation spasm in adulthood rarely happens and is predominantly secondary due to such causes as neurosis, hysteria , head injury (contusion or concussion ), menopause , etc. Professional activities associated with a small visual load (work of a watchmaker, jeweler, embroideress, etc.).

Accommodation Spasm Classification

Taking into account the reasons in ophthalmology, it is customary to distinguish several types of accommodation spasm:

  • Physiological (accommodative), arising as a response to visual overload, prolonged visual work in the vicinity of people with uncorrected long-sightedness or astigmatism . Physiological accommodation spasm requires the selection of spectacle correction and recovery of the ciliary muscle.
  • Artificial (transient), due to the action of certain eye preparations-miotics (pilocarpine, phospacol, ezerin, etc.). Artificial accommodation spasm does not require treatment, it disappears on its own after miotics are canceled.
  • Pathological accommodation spasm, accompanied by a change in refraction from hypermetropic and emmetropic to myopic and decreased visual acuity. Pathological accommodation spasm is divided into resistant and unstable; fresh (less than 1 year) and old (more than 1 year); uniform and uneven.

In the practice of ophthalmologists more often there is a mixed accommodation spasm, combining physiological and pathological mechanisms.

Symptoms of accommodation spasm

Subjective manifestations of accommodation spasm can be a deterioration in the clarity of vision into the distance, double vision, rapid visual fatigue from working at close range, a feeling of pain and burning in the eyes, pain in the eyeballs, temporal and frontal areas. Often there is redness of the eyes and tearing. Often, a child presents vague complaints of headache and fatigue; becomes irritable, his school performance decreases, which may be incorrectly regarded as an age-related restructuring of the body. The duration of accommodation spasm can vary from several months to several years, often turning into stable school myopia in children.

Pathological accommodation spasm is accompanied by both eye symptoms (anisocoria, nystagmus , eyelid tremor) and general manifestations. Patients may experience vegetative-vascular dystonia , emotional lability , decrease in mood, palm hyperhidrosis , trembling fingers, migraine attacks .

Diagnosis and treatment of accommodation spasm

A child complaining of visual fatigue or reduced vision should be examined by a pediatric ophthalmologist. The algorithm for examining a child with suspected spasm of accommodation includes determining visual acuity, volume and stock of accommodation, refractometry, skiascopy, and research on convergence. In order to identify the possible causes of spasm of accommodation, a child may be recommended an in-depth examination by a pediatrician, children’s neurologist, children’s traumatologist-orthopedist, etc. When diagnosing spasm of accommodation, complex treatment is prescribed, including hardware treatment, drug therapy, physiotherapy, health and hygiene measures.

Drug therapy for accommodation spasm involves the instillation of eye drops , relaxing the ciliary muscle (tropicamide, phenylephrine), vitamin therapy. Of the physiotherapeutic methods, electrophoresis and magnetictherapy are most commonly used . If the spasm of accommodation is caused by diseases of the spine, the patient may be recommended a course of therapeutic massage of the neck and collar area and back , acupuncture , manual therapy , and physical therapy .

For training the ciliary muscle effective software and computer module Relax, elektrookulostimulyatsiya , magnetic stimulation , laser stimulation , tsvetostimulyatsiya. At home, on prescription, Sidorenko glasses can be used (recommended for children over 3 years old). In order to consolidate the effect of the complex therapy of accommodation spasm, it is extremely important to improve the overall body’s health – a balanced diet, hardening, playing sports, hygiene of vision, and performing special exercises for the eyes.

Prediction and prevention of accommodation spasm

Accommodation spasm is a reversible functional disorder and can be treated successfully. Drug therapy quickly relieves spasm of the ciliary muscle due to its forced relaxation, therefore, to achieve a stable result, it is necessary to conduct a full range of therapeutic measures and eliminate the causes that led to the development of accommodation spasm. Early detection and treatment of accommodation spasm will prevent the development of myopia in children.

Prevention of accommodation spasm includes general health improvement of the body, frequent walks, good night rest, rational nutrition, physical education and sports. The important point is to comply with hygiene standards visual work: a good illumination of the working space, the correct seating posture and a sufficient distance in the monitor or book, regular breaks, etc. At hyperopia or astigmatism requires selection. Optical correction (glasses, contact lenses ) completion of functional rehabilitation courses.

Accommodation spasm is a functional impairment of vision caused by a prolonged spastic contraction of the ciliary muscle that continues in conditions where focusing near is not required. Accommodation spasm is accompanied by a decrease in visual acuity at a distance, rapid fatigue when performing visual work at close range, pain in the eyeballs, temples, frontal area. Accommodation spasm is detected by an ophthalmologist during a comprehensive examination (visometry, determination of refraction and accommodation stocks). Treatment of accommodation spasm includes hardware training, instillation of eye drops, physiotherapy (electrophoresis, magnetic therapy, laser therapy).

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