Clinical Overview of Anomalies of Accommodation: Diagnosis, Types, and Management Strategies

This presentation provides a comprehensive guide to anomalies of ocular accommodation, a key aspect of binocular vision and refraction. It covers:

Normal accommodation physiology: role of the crystalline lens and ciliary muscle

Types of anomalies:

Insufficiency: reduced accommodative amplitude (e.g. premature sclerosis, systemic illness)

Paralysis: complete loss due to neurological or pharmacological causes

Presbyopia: age-related decline in accommodation
Excessive accommodation: often seen in uncorrected hyperopes

Spasm of accommodation: involuntary, sustained contraction causing pseudomyopia

Clinical signs and symptoms: blurred near vision, asthenopia, headaches

Diagnostic tests: amplitude of accommodation, accommodative facility, near point of accommodation

Management: optical correction, vision therapy, pharmacological intervention

1. By
Azmat jehan

2. Anomalies of accommodation
Increased accommodation
Excessive accommodation
Spasm of accommodation
Diminished accommodation
Insufficiency of accommodation
Ill-sustained accommodation
Paralysis of accommodation
Cycloplegia

3. EXCESSIVE ACCOMMODATION:
Excessive tone of the ciliary muscles causing certain degree
of sustained accommodation
Of unknown etiology
Mostly occurs in young people and mostly in
hypermetropes.
More associated with near work
A condition of artificial myopia is produced.
A hypermetrope appears myopic and a myope more so.
Both the far and near point are brought nearer to the eye.
Treatment is atropine and near work should be forbidden.
Anomalies of accommodation
Cont’d

4. ◉SPASM OF ACCOMMODATION:
Mostly occurs in young glaucoma patients using
pilocarpine, especially if myopic.
True spasm is rare.
Macropsia is a feature.
Treatment is production of complete ciliary
paralysis with atropine for a longer time (about 4-
weeks)
Anomalies of accommodation
Cont’d

5. INSUFFICIENCY OF ACCOMMODATION:
The accommodative power is constantly below the lower limit of
what may be accepted as the normal variation for the patient’s
age.
Caused by one of the two factors.
•Undue sclerosis of the lens
•Weakness of the ciliary muscles
Associated with anemia and malnutrition
Mostly accompanied by an excessive use of the eyes, especially
for close work
Treatment include, treatment of cause, correction of the
refractive errors, addition of prism if there is associated
convergence insufficiency and accommodation and convergence
exercises.
Anomalies of accommodation
Cont’d

6. ILL-SUSTAINED ACCOMMODATION:
Is essentially the same condition as the
insufficiency, but less accentuated.
The range of accommodation is normal, but on
any attempt to use the eyes for near work over a
prolonged interval, the accommodative power
weakens.
Frequently, it is the initial stage of a true
insufficiency.
Anomalies of accommodation
Cont’d

7. PARALYSIS OF ACCOMMODATION:
This may occur from local or general causes.
Most important local cause is the exposure of eye
to cycloplegic medications
Trauma may be another important local cause.
More general causes act either on the mid-brain or
on the para-sympathetic nerve supply in the 3
rd

nerve nucleus, Micropsia is often associated with
accommodative paralysis.
Anomalies of accommodation
Cont’d

8. CYCLOPLEGIA
The state of paralysis of the ciliary muscles
Cyloplegia is the term mostly used for that type of
accommodative paralysis, which is achieved by
instillation of cycloplegic drugs into the eye.
Atropine, Homatropine, Scopolamine, and
cyclopentolate are the popular examples of
cycloplegics.
Atropine is the strongest cycloplegic ever known.
Atropine abolishes all para-sympathetic activity by
preventing the penetration of acetylcholine into the
effector muscle cells.

9. In most of the pharmacological cycloplegia,
dilatation of the pupil starts earlier and
vanishes earlier than the cycloplegia.
CYCLOPLEGIA
Cont’d

10. Causes of Accommodative
anomalies
oFollowing trauma
o inflammatory
oToxic
oMetabolic( diabetes,grave disease)
oDegenerative