2020–2021 BCSC Basic and Clinical Science Course™
3 Clinical Optics
Chapter 4: Clinical Refraction
Clinical Accommodative Problems
Ciliary muscle spasm, often incorrectly termed spasm of accommodation, causes accommodative excess. A ciliary spasm has characteristic symptoms: headache, brow ache, variable blurring of distance vision, and an abnormally close near point. Ciliary spasm may be a manifestation of local disease such as iridocyclitis; it may be caused by medications such as the anticholinesterases used in the treatment of glaucoma; or it may be associated with uncorrected refractive errors, usually hyperopia but also astigmatism. In some patients, ciliary spasm exacerbates preexisting myopia. Postcycloplegic refraction often helps determine the patient’s true refractive error in such cases.
Ciliary spasm may also occur after prolonged and intense periods of near work. Spasm of the near reflex is a characteristic clinical syndrome often observed in tense or anxious persons who present with (1) excess accommodation, (2) excess convergence, and (3) miosis.
Excerpted from BCSC 2020-2021 series : Section 3 - Clinical Optics. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.