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

[anonymous951]

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, FAAO]

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

[anonymous951]

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, FAAO]

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[anonymous951]

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, FAAO]

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