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Spasm of accommodation associated with closed head trauma
R V Paul Chan1, Jonathan D Trobe
1The Departments of Ophthalmology (Kellogg Eye Center) and Neurology, University of Michigan Medical Center, 1000 Wall Street, Ann Arbor, MI 48105, USA.
Summary
Accommodative spasm causing pseudomyopia can occur after head injuries in young men. This vision issue, characterized by significant pseudomyopia, persisted for years, suggesting a link to brain stem centers.
Area of Science:
- Ophthalmology
- Neuroscience
- Traumatology
Background:
- Accommodative spasm, leading to pseudomyopia, is typically linked to the near reflex or psychogenic factors.
- Pseudomyopia is defined as the difference between manifest and cycloplegic refraction.
Purpose of the Study:
- To investigate accommodative spasm as a consequence of closed head injury.
- To characterize the clinical presentation and duration of post-traumatic pseudomyopia.
Main Methods:
- Retrospective case series of six male patients (ages 16-37) with closed head injuries.
- Assessment of pseudomyopia using manifest and cycloplegic refractions.
- Long-term follow-up, including a 3-year trial of pharmacologically induced cycloplegia in one patient.
Main Results:
- Six male patients developed accommodative spasm and pseudomyopia (1.5-2 diopters) following head trauma.
- Pseudomyopia persisted for at least 7 years post-injury.
- Pharmacological cycloplegia did not reverse the spasm upon cessation.
Conclusions:
- Closed head injury can induce persistent accommodative spasm and pseudomyopia in young males.
- This condition may result from traumatic alteration of brain stem accommodation centers.
- Patients often require manifest refraction for clear distance vision due to enduring pseudomyopia.