Severe spasm of accommodation - Neurologist or Ophtalmologist ???

[Milos]

My current diagnosis are Asthenopia, Spasm of accommodation and Insomnia. I will try to point out the main facts in order to find any helpful advise because I think this condition in which I am is unbearable and impossible to live with This question Im going to post in both neurology and eye care sections because it is related.

After often prolonged time of reading I noticed that i cant see distance objects and first glasses (-0.5) were prescribed to me.  But the problem was that every time i should have worn them I felt strong pain in my eyes and headache, especially it was hard to watch close objects with glasses so I decided not to wear them except in situations when i had to. However as time was passing I felt worse and worse and doctors prescribed me stronger glasses what resulted in more severe problems. (-1)

Doctors decided to send me on binocular tests and found that I have very low fusion of eyes and told me that in order to improve it I have to wear the glasses (even stronger -1.75) with theory that better individual pictures would improve binocular vision) all the time despite the strong pain and prescribed exercises.

However, this made my condition even more worse. Binocular  exercises haven't helped at all  Since then I have CONSTANT pain in my eyes and headache which is so strong that I am NOT ABLE TO SLEEP. Then the other ophthalmologist found that I have severe CILIARY SPASM and decided to send me to neurologist who prescribed to me   Lorazepam which didn't help and then Flormidal (both before sleeping) which also didn't help me to sleep and relax muscles  I would like to add that since i stopped to wear glasses visual acuity tests showed -0.5.

If I understand well I had ciliary spasm since the beginning but was more made complicated with minus lenses cause they make more pressure on ciliary muscle. How to find the way from this condition ???

I would be very grateful for any advice,

Thanks,

Milos

[John C Hagan III, MD, FACS]

minus (-) lens will NOT help accommodative spasm, in fact it may make them worse. You ne plus (+) lens and then just for reading.

See a neuroophthalmologist. Do not let the staff put any drops in your eye till you see the Eye MD. Also ask for a "fogging refracting" before drops and a "post cycloplegic refraction" after eye drops.

Find a Eye MD with neuro speciality near you at www.aao.org

JCH MD

[Milos]

Thanks for advice doctor Hagan,

I'm going to neuroophtalmologist in next several days. Hope that damage to my nerve system is not so heavy and will find the way how to relax ciliary muscles. I cant describe how strong the pain is.

Gonna post news as soon as I find out anything.

Milos.

[John C Hagan III, MD, FACS]

Good luck. Remember again to see the neuroophthalmoloigst before drops put in and that you have been told you have spasm of accommodation.
JCH MD

[Milos]

I went to neuroophtalmologists, she concluded that spasm is so strong that eyedrops couldnt have realese it for 3 days so she ordered to me to continue  usage neurological pescription  for general  muscles relaxation lorazepam, propranolol, vitamins b6 i E. and arranged to have VEP test in February.

Thx Dr Hagan

[John C Hagan III, MD, FACS]

Good luck, sounds like you are in good hands.

JCH MD

[Milos]

I did VEP test and it showed monocular amplitudes normal for both eyes but very low amplitude for binocular vision. Last prescription is -0,5 only for distance viewing but Im afraid to wear glasses cause wearing made my condition much worse till i reached -1.75 and gain all-day headache. Still have strong headaches and not sure how to deal with it.

Grateful for opinion.

thx

[John C Hagan III, MD, FACS]

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[Milos]

Stil have constant ciliary pain, headache. I feel strong contractions when trying see objects at different distances. Dont wear glasses cause even with smallest prescription I can feel stronger pressure when to accommodate. Ive been using therapy propranolol 2x10 mg and lorazepam before sleeping for a long time without visual improvements.

Another doctor told me to try amyzol cause it has as side effect reduction of  accommodation. Im very afraid of new experiments and would be grateful for any advice.

Also would like to ask which eye exercises are good for this problem cause it seems to me that sterograms and pencil pushups even make thing worse and more tension in ciliary muscles.

Thx

[John C Hagan III, MD, FACS]

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[Milos]

Dear dr Hagan,

Im back with some fresh news. Last prescription is -0.25 and  -0.5 but spasm is still present and strong pain with headaches. It seems that I was all the time hypermetropic but was treated with strong minus lenses (-1.75)

I would be very grateful for opinion whether to use plus lenses for reading because close work is real torture for me.

Thanks for all advices

[John C Hagan III, MD, FACS]

If you will note in my first response the reason I suggested Fogging Refraction and post cycloplegic refraction was to make sure you weren't over corrected for myopia (and you were)./

If you are still symptomatic then I would suggest reading glasses, perhaps with base in prism.  If you have to look up from your work a lot you may want to get half glasses (Ben Franklin type)

JCH MD

[Milos]

My job includes prolonged reading which makes strong effort to my ciliary muscles so certainly I need reading glasses

How to know what is the best plus  correction. I have read that it should be fuller.

Thanks

[John C Hagan III, MD, FACS]

That should be determined by the neuroophthalmologist you should be seeing.

JCH DM

[Milos]

Dear dr Hagan,

In my country its very hard to find neuroophtalologist who is well aquainted with this problem. They just send me to neurologist for therapy.

I went to 2 neurologists-One prescribed lorazepam before sleeping, small dosage of propranolol during the day plus vitamins.

The second one prescribed me small dosages of rivotril but 3 times per day.

Both therapies helped me to sleep but havent helped me to relieve spasm and pain. Even small dosages of sedatives make my binocular fusion weaker.

I have  read in the article by Harvard professors  that it should be prescribed belladonna alkaloids and just mild sedatives (cause ciliary muscles are smooth) as stronger sedatives alone negatively affect binocular vision.

Would be very grateful for your opinion

[Milos]

In the end it is discovered that all the time I have had pseudomyopia and spasm of accommodation had basis in uncorrected latent hyperopia. Minus lenses have  just made the things worse. I would remind that in one moment -2 was prescribed. Still have strong asthenopic symptoms and unbearable headache. Doctor is against plus lenses but it is very hard to read due to strong pain. She prescribed me only change of focus training.

Thanks for any advice