Severe spasm of accommodation - Neurologist or Ophtalmologist ???

[anonymous951]

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

[letty2387]

Hello. I starting experiencing spasm of accomodation after lasik 3 years ago. 2 times in the first year, i went to several doctors that coldn't diagnose it but in time everything went back to normal. For 2 years i had no problem, but now, it lasts for 3 month already and it is getting worse.

Doctors say not i have only 50% vision in my left eye and i am in the point in whitch it hurts to move my head. They refuse to treat me with drops, because it can cause other problems. I have tried tropicamide at home, in the night for 2 weeks but i am afraid to use it more.

My left eye responds very slow even to drops, at the consult i had to wait for 1 hour and a half instead of 40 mintes after the second series of drops, in order for my left eye measurements to drop at -0.25.

I am very scared, can this cause regresion of my myopia? Now i am trying to use -0.5 glasses in the distance in order to alleviate my head aches and my nausea. Seems like my eyes respond to glasses, i clearly see better far objects.

Doctors say i shold wear them all the time. I am also concerned i will not be able to take them off and my cilliary will not want to do his job anymore. And couuld this cause regresion for myopia?

[JohnHaganMD]

A key issue here is your age.  What is it?

[letty2387]

30 and i had lasik at 27

[letty2387]

and i have -0.5 lens in the eye with problems (50% vision) and i see perfectly with it, but still focusing problems and pain when i move my eyes

[JohnHaganMD]

I'm making some assumptions here:  1 you have seen an eye MD ophthalmologist and a dilated (cycloplegic) refraction (glasses test) done to be sure you are not now farsighted (hyperopic).   If that is not the case that is what you need done now.   If it is the two most common problems would be  1. post lasik dry eye.  Use the search feature and archives and read about treatment of same.   2. Convergence insufficiency which is not the same as convergence spasm and reading glasses often with base in prism are often useful.

[JohnHaganMD]

Answered your other post.

[JohnHaganMD]

From what. This was first posted in 2008 and no posts since 2012. If you mean spasm of accommodation, no that never causes blindness.

JCH MD

[Cwahl09]

I've gone 3 to 4 hours of not being able to see 6 inches in front of me.  And not just l one.  Have 3 note books dedicated to them and Been threw 2 years of vision therapy whereas they and many others state it's permanent and I do go functionally blind

[JohnHaganMD]

=

[Wicsee]

Can you go blind from this

[Eyes123]

Pozdrav,

I am having the same visual issues. 'i've been to multiple doctors of different expertise, but havent received promising information.  After conducting experiments, and research on my own, I noticed that relaxing the accommodating muscle spasm is imperative.  I've asked to be prescribed small doses (.01% altropine) of altropine.  Please contact me as we can discuss this futher.  

[Eric047]

Yes...that is true...i also have accomodative spasm...the doctor prescribed me .01% atropine twice a day...it has helped but only to a certain extent...it has been around 2 weeks now...but the problem is that the doctor had prescribed me with learning glasses as well...however i feel pain in my eyes when using them and hence i only use the distance glasses for reading...that way the pain is less.

[John C Hagan III, MD, FACS, FAAO]

Not sure what 'learning' glasses are but tell your eye MD about how they make your eyes feel.

[venjer]

go to a doctor who can examine your vision acuity with 2% Cyclogyl (a brand by alcon, cyclonpentolate is the generic name) and that has an Auto-Refractor Machine also known as Objective Refraction.

(1) have them examine your eyes with Auto-Refraction (machine -this take 15 seconds) when you arrive before the cycloplegia effect

don't forget to take the print of your RX from the machine

(2) instill one drop of 2% Cyclogyl in each eye, and maintain your eyes shut until the next instillation

(3) maintain your eyes shut for 10 minutes (set an alarm clock)

(4) instill 2% Cyclogyl

(5) maintain your eyes shut for 10 minutes (set an alarm clock)

(6) instill 2% Cyclogyl for the third time

(7) maintain your eyes shut for 40 minutes (set an alarm clock), 30 minutes could also work but wait 40 min if possible

(8) have them  examine your eyes with Auto-Refractor machine (it take 15 seconds)

don't forget to take the print of your RX from the machine

and you're done !

(9) Ask to measure your dual PD , they should give you 2 PDs number, one for each eye. That mean, you ask them to measure the PD for each eye separately. PD for each eye should be in the range of 24-35
* if they give u a single PD in the range of 50-70 ask for dual aka 2 PDs

**(10) cycloplegia subjective refraction-IS NOT RELEVANT TO OUR GOAL. they would probably insist you perform subjective refraction as well - this is when doctor switch different lens power and ask you how well you can see



**From our point of view, the problem with subjective refraction is that the the more you use your eyes, and the more effort impose on the focus muscles, the more it set off and reduce the Cycloplegia effect.  What happen is that the relatively long process of the subjective refraction, combined with the effort imposed on your ciliary muscles reduce the Cycloplegia effect, and therefore distort the refraction result.

Many doctors do not fully understand this point and its importance, in particular with patients with muscles problems like you, me and others.

[aaron1981]

Hello...

I began having very intense headaches about two years ago.  I’d never had any ocular problems beforehand.  My primary care physician felt it was tension headaches and prescribed flurbiprophen....which did nothing.  A CT scan was done to prove that it wasn't Sinus related....the CT scan was clear.
He sent me to a well respected opthomalogist.....who thoroughly checked my eyes and sent me home with a clean bill of eye health.  Meanwhile, the headaches were persistent and very VERY intense.

He then sent me to a neurologist.  She did all the cranial nerve tests and concluded honestly, that she didn't know what I was suffering from.  She prescribed Topamax.....which made the headaches worse, giving me the overwhelming sensation of wanted to sleep.....all the time.

I scheduled an appointment at the Novus Clinic (Akron) for another opthomalogist session.  He concluded (in a 7 minute visit on his part), that I was suffering from presbyopia, even though I mentioned the possibility of Accomodation Spasms, after doing some research on my own.  The doctor (James Johnston) in his arrogance, suggested I was incorrect in diagnosing myself.

Getting no relief, I looked into a headache specialist.  A MRI was ordered with contrast, as was an MRA.  Basic blood work was also taken.  No conclusions.  Over a period of several months, he prescribed several migraine/cluster headaches drugs (ie. Imitrex, Migranol, Amitryptiline, Neurontin and Prednisone), of which NONE improved the headaches.

Family and friends gave many suggestions, since the doctors weren't helping.
My sister, who'd had previous eye problems, suggested a Neuro-Optho doctor.  Upon my first visit, after almost two years of intense pain (VERY INTENSE), several nights of vomiting, missing work, roller-coaster emotional cycles (because of the pain), and many many sleepless nights.....she concluded within a few minutes.....that I was suffering from Accomodation Spasms.....something I'd mentioned to one of the two Ophomalogists I'd seen almost a year earlier.

The doctor prescribed some ‘computer glasses’ (plus side), and has mentioned that
over time, the ciliary muscles need to be ‘re-trained’ into believing they can
relax.  I am having the prescription filled today, and will start wearing them at work,
tomorrow.

All of the above took place at the Cleveland Clinic.

The question still remains though…..what can be done about the pain?

Thanks,
Aaron1981

[3rdrock]

I have been experiencing ciliary muscle spasms for 20 years. I diagnosed it myself after bloodtests, MRI, an opthomologist saying it was dry eye and given restasis that never stopped the pain. All specialists tests revealed nothing definitive. This always was extreme pain surrounding my iris's so painful (either eye at times of spasms) to even so gently touch near them,  constant pain.  In the end diazepam 10mg stops the pain, this compound was discovered during the course of use after a neck injury.  when it's very bad take one then hydrate yourself with water intake,  then take a nice warm shower letting the warm water massage your closed eyes. Get into a comfortable bed and rest well even falling asleep. Continued intake for a while of 1/2 pill every two or three days helps the ciliary muscles heal.  My doctors believe me!

[JohnHaganMD]

Might help as diazepam anti-anxiety and muscle relaxant.

[Dr_Haitham]

unilateral spasm of accomodation after lasik ?!!
2 years post-lasik..my patient's refraction is  -3.00 O.D.  +0.25 O.S.  after cyclop. refraction is  (0.00 O.D)  (+0.25 O.S.) what's the best management ?
( cyclop. drops or what ? ) please reply me......thanks

[rotastrain]

The solution:


I am a medical student from the last three years.I have a older brother who also was in college with me.

I will explain his histroy first

My brother used to allways have cold hands and feet after travelling or reading from when i can remember.At that time he never had any symptoms but had a occasional severe muscular cramp in the stomach.
As time went by and his reading activity increased by the tim he was 18 he started showing a myopia.COREECTING THE MYOPIA MADE IT HELL FOR HIM.He stoppd using spectacles and was contet with blurred vision.

As time went by he started complaining of a vertigous feeling when travelling by car.A muscle tightining started occuring in his body.He would feel as if his back is stiff.All this inreased on reading.

Slowly the problem got worse and now his myopia was -4.00
No avail and made things even worse

When his second year of mbbs was done he decompensated with massive pain in legs hands back neck blurred vision vomiting vertigo and was unable to walk

We took him to eurorpe to a neuro opthalmologist in a WHEEL CHAIR

HE WAS DIAGNOSED WITH SPASM OF ACCOMODATION .CAUSE: ExOPHORIA

Treatment and progress was slow.I gave up my second year in college to RESERACH this problem

Contradictory to belief a BASE OUT PRISM WILL MAKE THINGS MUCH MUCH WORSE

The patient must be relaxed using a base in prism and all such patients are actually hypermetrops.Its been two years now and his spasm is at a level where he can walk now but CANNOT READ..


A professor call Proffesor Dr.Muehlendyck in GOTIINGEN Germany is the right person for this.He is a neuroopthalmologist and strabologist and HIMSELF HAD THIS PROBLEM and solved it himself.

I wish you all the best

[anonymous951]

Thanks one more time a lot for all your kind help dr Hagan.

Wish you all success.

[John C Hagan III, MD, FACS, FAAO]

anonymous951: I will not carry this conversation further. I told you that it is a rare condition. It is a condition I have not seen in my practice. What I know is what I've read in medical journals and scientific journals. You can access these yourself. I like www.emedicine.com  

Good luck.

JCH MD

[anonymous951]

Dear dr Hagan,

I would be grateful for your opinion about home or clinic vision exercises in this condition. Exercises were prescribed to me before spasm was discovered and they made more suffering to me cuase i did push ups, fusion exercises and prisms ALL WITH MINUS GLASSES ON and it had as result inducing stronger spasm and this neverending ciliary pain and headache.

So would I have any benefit of doing exercises in this state WITHOUT GLASSES. In my opinion not cause all exercises are done in close so ciliary muscle would be constricted to maximum power.(WITH MINUS GLASSES ON EVEN BEYOND ITS EXTREMES) Maybe only change of focus looking at finger and distance may have some usefulness.

Thanks

PS sorry by mistake I posted this question also in another topic

[John C Hagan III, MD, FACS, FAAO]

5% would probably work better.

Let me give you full disclosure. Spasm of accommodation is very rare. Few ophthalmologists (including me) have much experience treating it. Most treatment is down by neurooopthalmologist or strabismus specialists.

JHaganMD

[anonymous951]

Thank a lot dr Hagan,

Your help is very important for me. I hope the worst days have gone. What a shame for all ofthalomologists who made this suffering to me. Many of them even dare to regard themselves university professors, PhDs and are not able to check cycloplegic refraction of paitent with such symptoms.

I used earlier  Homatropine 2%, so maybe I should try Homatropine 5% or Atropine 1%. What is your opinion for how many days I should instill it.

I found in one article this citation:

The cycloplegic must be carefully chosen and properly administered. Full mydriasis is not
necessarily an indication of full accommodative relaxation. A spasm of accommodation
is often induced or aggravated in the early stages of cycloplegic
drug action (SLOANE, 1970). In such cases, atropine is the drug of choice and
should be used over several days. It is, however, possible to use the short
acting cycloplegic agents such as cyclopentolate if one waits the proper amount
of time for full effect to have taken place.

When I told that to one of "my professors" he answered that it is not true. He regard that it is enough instilling cyclopegics half hour before an examination. When I told to him that Harvard professors wrote that he was annoyed and comented that Harvard professors are ordinary ophtalmologists not better than any other.

I would like to add one more interesting fact that after I visited 4 PhD, mostly professors he was the first who found out that I have spasm of accommodation by fogging method but even him didnt make cyclopegia but his idea was to wear contact lenses -1.75 instead of glasses. Thanks to him for diagnosis but luckily I suspected to this idea and started own research. Before I visted him I was already in horrific condition. If I listened to him who knows what would happen with me.
I believe in USA is not possible that somebody have misfortune like me.

Thanks

[John C Hagan III, MD, FACS, FAAO]

Homatropine 5 % three times per day will generally relax even a young constricted ciliary muscle. No problem with trying atropine 1% twice/day other than it takes longer to wear off. If your RX cycloplegic is -0.25 you don't need glasses for distance and should be able to read with a cheap over the counter +2.50 for reading and +1.50 for computer and shopping.  After drops are stopped you will feel more comfortable with smaller numbers.

JCH MD

[anonymous951]

So its really unbelievable destiny that despite I complained to so many optalmologists since I started to study that reading make hard effort for my eyes and (in the beginning reversible) distance blur and they told me that it is normal and to come back when it get worse. After each returning with complaints that I have pain while wearing minus glasses they would prescribe stronger minus. And they kept rising it till -1.75 WITHOUT CYCLOPLEGIA. When I asked why they use drops for some people not for me they answered that drops are for people who dont see to read and that I dont need it. You really cant imagine what horror of life was made by such ignorance.

With complete reducing of reading i manage more often to have clear distance view but its variable with blinking. Eyepain and headache  still never stop. I would like to point out that my eyes and nervous system have been tortured with minus glasses for almost 10 years.

Cocernning the fact that I needed 3 weekends applying homatropine to realese accommodation form -1.75 to -0.75 and after 1 year of abstaing of close work and one more time of applying homatropine for 3 days my manifest refraction is -0.25 and I am finally able to see clearly on moments (bliking interrupts it) it can be proof that strong spasm cant be relieved with several days of applying homatropine.cause complete nervous system is affected.

So lets go to the questions...

1)I would be grateful for an advice whether atropine (cause it is stronger then homatropine) is worth of trying to reveal the true refractive error.

2) My second question concerns whether computer refraction values have any relevance in the case of spasm of accommodation.

In the end would like to add that I am conscious of importance of prisms and plus glasses for reading but I still havent found ophtalmologist who is aware of that to prescribe me and trying to relax accommodation with more timr spent outdoors and abstaing of reading.

Thanks

[nathandewinter]

its usually treated with atropine over a period of 2 weeks or so,im just not sure of the correct dosage,also you would need to ensure that you dont have any indications glaucoma present before strating the therapy.

strange that apparentely no doctor mentioned this to you?

apart from that,abstain from near work,or looking at a computer or lcd/plasma tv screen.

what helped me improve my vision a bit and relaxing my eyes and relieving the type of headaches that seem to come from your eyes was watching in the distance through a pinhole in a cartonboard,getting a clear image this way. with both eyes or covering the other eye..i would do this on the average 1-1.5 hours a day for each eye or 2-3 hours for both eyes

NOT SURE at all if this has anything to do with this kind of spasm since im not sure yet that i have it,but it could be that your muscle relaxed from the clear image stimulus even more so cause my eyes seem to get a bit flatter and softer after that which could indicate a flatter lens caused by the more relaxed state of the ciliary muscle

sometimes soon after that i would start to get headaches when doing near work. but on the overall i dont have that much trouble with headaches as with eyestrain and a general feeling of eye fatigue

make sure that you cover your eyes with the sufficiently protective and sunglasses if/when using atropine or any other mydriatic and avoid bright sunlight

if you have any additional information about treating/preventing this or symptoms in general free to contact me, i am gonna make an appointment to undergo a retinoscopy under atropine to be sure what's the matter here

pozdrav,

ntn dw

[John C Hagan III, MD, FACS, FAAO]

-

[venjer]

It has been EXTREMELY painful process and images kept rotating, sometime I would see only with my right eye while my left eye vision is extremely foggy/hazy to the extent that it can't see, and other time I would be able to see only with my left eye and not be able to see with right eye, as well as other weird visual stuff, which are the result of the moving and rotating involuntary!!!

[venjer]

hi this phenomena you're describing is very rare, so hopefully, thanks to this community by forcing hands, we could go to the root of that.

I'm a patient that suffers from a similar condition:

No Doctor could have helped me (Ophthalmologist, Optometrist, etc

The problem is that each professional focuses on a narrow area of expertise, so no professional is able to SEE the big picture. They failed to understand that everything is intra-related and affect one another. The result is that the Left hand doesn't know what the right hand is doing....

[John C Hagan III, MD, FACS, FAAO]

If everything fails then using a cycloplegic drop like homatropine or cyclogyl and progressive bifocals for a while is worth trying

JCH MD

[anonymous951]

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

[anonymous951]

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

[John C Hagan III, MD, FACS, FAAO]

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

JCH DM