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Avatar universal

Severe spasm of accommodation - Neurologist or Ophtalmologist ???

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

36 Responses
233488 tn?1310696703
MEDICAL PROFESSIONAL
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
Avatar universal
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.
233488 tn?1310696703
MEDICAL PROFESSIONAL
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
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
Good luck, sounds like you are in good hands.

JCH MD
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
-
Avatar universal
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


233488 tn?1310696703
MEDICAL PROFESSIONAL
-
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
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
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
That should be determined by the neuroophthalmologist you should be seeing.

JCH DM
Avatar universal
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
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
If everything fails then using a cycloplegic drop like homatropine or cyclogyl and progressive bifocals for a while is worth trying

JCH MD
Avatar universal
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....
Avatar universal
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!!!
233488 tn?1310696703
MEDICAL PROFESSIONAL
-
Avatar universal
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
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
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
Avatar universal
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
233488 tn?1310696703
MEDICAL PROFESSIONAL
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
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