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Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Infantile esotropia (Fig. 7.63) develops before the age of 6 months with a large and stable angle, crossfixation (child uses right eye to look to left and vice versa as the eyes are so convergent) and normal refraction for age. Non-accommodative esotropia: esotropia after 6 months of age with normal refraction.Refractive accommodative esotropia: onset is usually between 2 and 3 years, associated with hypermetropia (long-sightedness).Non-refractive accommodative esotropia: onset after 6 months but before 3 years. No significant refractive error but excessive convergence for near (called high accommodative convergence: accommodation ratio – AC/A ratio).Sensory esotropia: due to reduction in vision, with one eye much worse than the other, which disrupts fusion – e.g. in unilateral cataract.Convergent spasm: intermittent esotropia with pseudomyopia and miosis due to accommodative spasm, which may be seen after trauma or due to a posterior fossa tumour but usually has a functional element.
Treating Mild and Moderate Myopia
Published in John William Yee, The Neurological Treatment for Nearsightedness and Related Vision Problems, 2019
Mild myopia is sometimes referred to as “pseudomyopia.” When only the crystalline lenses had deviated, the tension of the oblique muscles can sometimes relax on its own without the assistance of a “contact lens draw.” The excessive tension was not enough to alter the shape of the eyeball, and it may subside when the external adverse conditions are removed.
Diplopia after Excessive Smart Phone Usage
Published in Neuro-Ophthalmology, 2019
Savleen Kaur, Jaspreet Sukhija, Rahul Khanna, Aastha Takkar, Manpreet Singh
Accommodative spasm is a relatively rare entity resulting from over stimulation of the parasympathetic nervous system. When combined with miosis, it is termed as spasm of the near reflex.1,2 In most cases the etiology is thought to be functional.1,2 The major symptoms include sudden onset of blurred vision because of apparent myopic refractive error (pseudomyopia), diplopia, limited ocular motility, ocular pain, and photophobia. Management includes inhibiting the excessive accommodation and excessive convergence using strong cycloplegic agents and/or plus lenses.2 Due to reports of recurrence after treatment, gradual tapering of cycloplegics is warranted.3 In our series also, we prescribed cycloplegics in all the patients and the symptoms decreased over a period of 3–6 weeks. The improvement in all patients with cycloplegics strengthened the possibility of accommodation spasm. However, in our series, we blame the use of smart phones as the culprit behind the accommodative spasm. This is because of a positive and reliable history of cell phone usage and the third patient getting relieved of symptoms without medication.
Spasm of the Near Reflex: Literature Review and Proposed Management Strategy
Published in Journal of Binocular Vision and Ocular Motility, 2018
There is a difference of opinion in the literature concerning minus lenses (or over-minusing) for the treatment of AS.5,13,14 A patient with sustained AS will have decreased distance visual acuity due to pseudomyopia. Minus lenses will improve visual acuity, but may also contribute to sustaining the AS. This “paradoxical” treatment may appear to be counter-productive,13,14 but there are examples where over-minusing can be beneficial. London et al. report a number of patients with post-traumatic AS. They state that “in general, it appears that if patients remain in the pseudomyopic state beyond the first six to nine months post-trauma, they remain recalcitrant to treatment and the full manifest minus lens correction is the only intervention that will relieve symptoms”.5
Performance of a photoscreener in detecting accommodation spasm
Published in Clinical and Experimental Optometry, 2022
Mehmet Siraç Demir, Ersin Muhafiz
In conclusion, there was a correlation between non-cycloplegic photoscreener (Vision Spot) and cycloplegic autorefractometer measurements in subjects with pseudomyopia due to intermittent AS. And the results of these two measurements were consistent with each other. Therefore, a photoscreener can be a fast, practical and cost-effective examination method for screening these patients without the need for cycloplegia.