Accommodative excess explained

Accommodative excess
Field:ophthalmology
Symptoms:asthenopia, blurring of vision

In ophthalmology, accommodative excess (also known as excessive accommodation or accommodation excess) occurs when an individual uses more than normal accommodation (focusing on close objects) for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patient's age. Modern definitions simply regard it as an inability to relax accommodation readily.[1] Excessive accommodation is seen in association with excessive convergence also.[2]

Symptoms and signs

Causes

Causes related to refractive errors

Accommodative excess may be seen in the following conditions:[3]

Causes related to systemic drugs

Use of systemic drugs like Morphine, Digitalis, Sulfonamides, Carbonic anhydrase inhibitors may cause accommodative excess.[4]

Causes related to diseases

Secondary to Convergence insufficiency

Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV.[5]

Risk factors

A large amount of near work is the main precipitating factor of accommodative excess.

Pseudomyopia

Pseudomyopia also known as artificial myopia [6] refers to an intermittent and temporary shift in refractive status of the eye towards myopia. It may occur due to excessive accommodation or spasm of accommodation.[7]

Diagnosis

Differential diagnosis

Parinaud's syndrome, which can mimic some aspects of spasm of the near reflex, such as excessive accommodation and convergence; however, pupillary near-light dissociation, not miosis, is a feature of Parinaud's syndrome.[8]

Treatment

See also

Notes and References

  1. Book: Borish's Clinical Refraction. 2. Accommodation, the Pupil, and Presbyopia. 112.
  2. Web site: accommodative excess .
  3. Book: AK Khurana . Theory and Practice of Optics and Refraction . Elsevier . 105–106 . 2 . anomalies of accommodation and convergence.
  4. Book: William J . Benjamin . Borish's Clinical Refraction . Butterworth Heinmann Elsevier . 114–115 . 2 . Accommodation, the Pupil, and Presbyopia.
  5. Book: Clinical Management of Binocular Vision . 4 . Mitchel Scheiman, Bruice Wick . Accommodative Dysfunction. 357.
  6. Book: Theory and Practice of Optics and Refraction . AK Khurana . 2. Errors of refraction and binocular optical defects. 77.
  7. A review of non-strabismic accommodative and vergence anomalies in school-age children. Part 2: Accommodative anomalies . Wajuihian SO, Hansraj R . African Vision and Eye Health . 28 August 2015 . 74 . 1 . 7 .
  8. Book: Current Ocular Therapy. Iris and Ciliary body . 518. Frederick Hampton Roy, Frederick W. Fraunfelder, Frederick T. Fraunfelder. 6 .
  9. Book: Clinical Management of Binocular Vision . 4 . Mitchel Scheiman, Bruice Wick . Accommodative Dysfunction. 354.