J Korean Ophthalmol Soc.  2015 Oct;56(10):1630-1634. 10.3341/jkos.2015.56.10.1630.

Methods and Effect of Management of Patients with Convergence Spasm and Aquired Pseudomyopia

• Kwon IJ
• Ha SG
• Kim SH

• KMID: 2214426
• DOI: http://doi.org/10.3341/jkos.2015.56.10.1630

Abstract

PURPOSE
To evaluate changes in the degree of pseudomyopia and prognosis in patients with convergence spasm and acquired pseudomyopia.
METHODS
The medical records of patients with convergence spasm and acquired pseudomyopia at the Korea University Medical Center from 2011 to 2014 were identified. We reviewed the patients' gender, age, onset time, visual acuity, refractive error, angle of strabismic deviation and the selected management (cycloplegics, patching, cycloplegics + patching, prism glasses).
RESULTS
At the first medical examination, the mean age was 20.08 years. The mean spherical equivalent was -3.75 diopter (D) in the right eye and -4.03 D in the left eye based on manifest refraction and -2.59 D in right eye and -2.85 D in left eye using cycloplegic refraction. Eleven of 12 patients had esodeviation with a mean esodeviation of 10.42 D. The pupil size was 3.63 mm in the right eye and 3.63 mm in the left eye. No patient experienced severe miosis (pupil size <2 mm). Observation (5), patching (3), cycloplegics (2), patching + cycloplegics (1) and prism (1) management were performed in 12 patients. Outcomes included completely cured (3), improvement (7) and no change or recurrence (2).
CONCLUSIONS
Active management is necessary for patients with convergence spasm and acquired pseudomyopia.

Keyword

Accommodative spasm; Convergence spasm; Near reflex spasm; Pseudomyopia

MeSH Terms

Academic Medical Centers
Esotropia
Humans
Korea
Medical Records
Methods*
Miosis
Mydriatics
Prognosis
Pupil
Recurrence
Refractive Errors
Spasm*
Visual Acuity
Mydriatics

Reference

References

1. Goldstein JH, Schneekloth BB. Spasm of the near reflex: a spec-trum of anomalies. Surv Ophthalmol. 1996; 40:269–78.

2. Cogan DG, Freese CG Jr. Spasm of the near reflex. AMA Arch Ophthalmol. 1955; 54:752–9.

3. Griffin JF, Wray SH, Anderson DP. Misdiagnosis of spasm of the near reflex. Neurology. 1976; 26:1018–20.

4. Sollom AW. Unilateral spasm of accommodation and transient convergent squint due to an anxiety neurosis. Br Orthopt J. 1966; 23:118–9.

5. Yang YR, Koh JW, Choi NY, Park SC. A Study of patients with spasm of the near reflex. J Korean Ophthalmol Soc. 2006; 47:1630–7.

6. Kim SJ, Lee JB, Kwak YS. A case of hysterical convergence spasm. J Korean Ophthalmol Soc. 1982; 23:817–21.

7. Rutstein RP, Daum KM, Amos JF. Accommodative spasm: a study of 17 cases. J Am Optom Assoc. 1988; 59:527–38.

8. Fitzgerald CE. Acute spasm of the accommodation. Trans Ophthalmol Soc UK. 1884; 4:311–5.

9. Keane JR. Neuro-ophthalmic signs and symptoms of hysteria. Neurology. 1982; 32:757–62.

10. Rutstein RP, Galkin KA. Convergence spasm-two case reports. J Am Optom Assoc. 1984; 55:495–8.

11. Souders BF. Hysterical convergence spasm. Archives of Ophthalmology. 1942; 27:361–5.

12. Sloane AE, Kraut JA. Spasm of accommodation. Doc Ophthalmol. 1973; 34:365–9.

13. Daum KM. Accommodative dysfunction. Doc Ophthalmol. 1983; 55:177–98.

14. Burian HM. Motility clinic: intermittent (facultative) divergent strabismus. Its influence on visual acuity and the binocular visual acuity and the binocular visual act. Am J Ophthalmol. 1945; 28:525–7.

15. Seaber JH. Pseudomyopia in exodeviations. Am Orthopt J. 1966; 16:67–72.

16. Schwartze GM, McHenry LC Jr, Proctor RC. Convergence spasm- treatment by amytal interview. A case report. J Clin Neuroophthalmol. 1983; 3:123–5.