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Functional Spasm of Accommodation: Changes on Scheimpflug Imaging

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Functional Spasm of Accommodation: Changes on Scheimpflug Imaging [Downloaded free from http://www.ojoonline.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Case Report Functional spasm of accommodation: Changes on scheimpflug imaging Jaspreet Sukhija, Mangat R. Dogra, Thara Zadeng, Jagat Ram Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India Spasm of accommodation is a rare condition functional disorder and the condition gradually improves. characterized by a sudden increase in myopia. It can We hereby present the changes occurring in spasm of occur in emmetropes, hypermetropes and myopes. accommodation as seen on Scheimpflug imaging. All the physiological changes that occur in normal accommodation are exaggerated. Mostly the cause is Keywords: Accommodation spasm, myopia, pentacam Introduction At presentation to us on the third day of her symptoms, visual acuity was 6/36 and 6/24 in the right and the left eye with –4 Spasm of accommodation is characterized by intermittent and dioptre spherical correction which she was wearing in both usually painful convergence, accommodation, and miosis in eyes. BCVA (Best corrected visual acuity) was 6/6 with manifest varying combinations with variable amount of time.[1] Various refraction of –7 diopter sphere OD and – 7.5/–0.5 × 70 OS. etiologies have been implicated, including functional spasm of Anterior segment examination revealed miosis, shallow anterior oculo-motor muscle, hysterical convergence spasm and emotional chamber in both eyes. Intra-ocular pressure on applanation distress.[2] The excessive accommodative tone usually causes tonometry was 14 and 16 mmHg in right and left eye, respectively. pseudomyopia.[3] We herein report scheimpflug imaging in a On Pentacam examination after dilatation with phenylepherine 5% patient with spasm of accommodation. drops, the anterior chamber depth was 1.64 mm OD and 1.57 mm OS. The crystalline lens thickness was 4.01 mm in the right eye Case Report and 4 mm in the left eye and the distance between the cornea and posterior pole of the lens was 5.65 mm OD and 5.57 mm OS [Figure 1a and 1b]. Cycloplegic refraction under cyclopentolate 1% A 17-year-old girl complained of sudden onset blurring of vision done 1 day later showed –1.5 dioptre sphere in the right and –1.75 in both eyes following prolonged reading under a dim light. It was dioptre sphere in the left eye and visual acuity of 6/6 OU. At this associated with mild headache and eye strain. She was a known time scheimpflug imaging showed an anterior chamber depth of case of myopia. Her refractive error was –2 diopters in both eyes. 2.98 mm OD and 2.95 mm OS with a lens thickness of 3.7 mm in Her records showed that her refractive error increased to –4 the right eye and 3.62 mm in the left eye and the distance between dioptre sphere on the day of her complaint and she was prescribed spectacles on the same day. She was on salbutamol inhaler for the cornea and posterior pole of the lens was 6.68 mm OD and bronchial asthma. 6.57 mm OS [Figure 2a and 2b]. No supraciliary effusion could be documented on ultrasound biomicroscope. A diagnosis of Access this article online accommodative spasm was thus made clinically and morphological Quick Response Code: changes were documented by pentacam. The patient was put on Website: cyclopentolate 1% drops once a day. www.ojoonline.org Discussion DOI: 10.4103/0974-620X.142601 Accommodative spasm is a condition where there is an involuntary, sustained accommodation in the absence of an Copyright: © 2014 Sukhija J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Correspondence: Dr. Jaspreet Sukhija, Assistant Professor, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected] 150 Oman Journal of Ophthalmology, Vol. 7, No. 3, 2014 [Downloaded free from http://www.ojoonline.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Sukhija, et al.: Spasmaccomodationpentacam a b Figure 1: (a) Scheimpfl ug image of the right eye during accommodative spasm after dilatation with phenylepherine 5% drops objectively reveals shall anterior chamber along with lenticular parameters. (b) Scheimpfl ug image of the left eye showing a similar picture a b Figure 2: (a) Scheimpfl ug image of right eye after dilatation with cyclopentolate 1% drops. Note the increase in the anterior chamber depth with a decrease in lens thickness and posterior movement of the crystalline lens. (b) Scheimpfl ug image of the left eye with similar fi ndings accommodative stimulus. The anterior lens becomes more sharply by Strenk et al. reported no movement of the posterior lenticular curved, moving closer to the cornea.[4] Baikoff et al. analyzed the surface during accommodation whereas Bolz et al. have showed anterior segment changes during accommodation using optical posterior movement.[6,7] Koretz et al. showed that in young adults coherence tomography (OCT).[5] They found that the anterior the posterior lens surface may tend to move posteriorly a short pole of crystalline lens moves forward during accommodation and distance as well, so that total anterior segment length may increase there is a linear relationship between this movement and anterior slightly whereas in adults this surface moves forward adding to the radius of curvature. Accordingly the posterior curvature decreased decrease in anterior chamber depth.[4] Tsorbatzoglou et al. found proportionally. Controversy still exists as to the movement of the by partial coherence interferomtery that the decrease in ACD was posterior lenticular surface during accommodation. Recent study greater than the increase in anterior segment length (ASL) and thus Oman Journal of Ophthalmology, Vol. 7, No. 3, 2014 151 [Downloaded free from http://www.ojoonline.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Sukhija, et al.: Spasmaccomodationpentacam hypothesized that the crystalline lens move forward simultaneously 3. Smith JL. Accommodative spasm versus spasms of the near refl ex. J Clin Neuro-Ophthalmol 1987;7:132-4. during accommodation.[8] Dubbelman et al. found significant 4. Koretz JF, Cook CA, Kaufman PF. Accomodation and presbyopia in the anterior movement of the human lens during accommodation.[9] In human eye. Invest Ophthalmol Vis Sci 1997;38:569-78. our young patient we observed forward movement of the posterior 5. Baikoff G, Lutun E, Ferraz C, Wei J. Static and dynamic analysis of the lenticular surface as well. It may be hypothesized that this anterior anterior segment with optical coherence tomography. J Cataract Refract movement of the posterior surface of the crystalline lens occurs Surg 2004;30:1843-50. in accommodative spasm which contributes to the increase in 6. Strenk SA, Strenk LM, Koretz JF. The mechanism of presbyopia. Prog Retin Eye Res 2005;24:379-93. accommodative amplitude. A myopic patient will appear to be 7. Bolz M, Prince A, Drexler W, Findl O. Linear relationship of refractive and more myopic, a hyperopic patient will appear to be less hyperopic biometric lenticular changes during accommodation in emmetropic and and an emmetropic patient will appear to be a myopic. myopic eyes. Br J Ophthalmol 2007;91:360-5. 8. Tsorbatzoglou A, Nemeth G, Szell N, Biro Z, Berta A. Anterior segment Scheimpflug imaging is an important tool in objectively changes with age and during accommodation measured with partial coherence interferomtery. J Cataract Refract Surg 2007;33:1597-601. quantifying the changes in accommodative spasm. 9. Dubbleman M, Van Der Heijde GL, Weeber HA, Vrensen GF. Changes in the internal structure of the human crystalline lens with age and References accommodation. Vision Res 2003;43:2363-75. Cite this article as: Sukhija J, Dogra MR, Zadeng T, Ram J. Functional spasm 1. Cogan DG, Freese CG. Spasm of the Near Refl ex. Arch Ophthalmol of accommodation: Changes on scheimpfl ug imaging. Oman J Ophthalmol 1955;54:752-9. 2014;7:150-2. 2. Goldstein JH. Spasm of the Near Refl ex: A Spectrum of Anomalies. Source of Support: Nil, Confl ict of Interest: None declared. Survey Ophthalmol 1996;40:269-78. 152 Oman Journal of Ophthalmology, Vol. 7, No. 3, 2014.
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