Case Series: Periodic Accommodative Fluctuations after Concussion

This is the first report recording an accommodative disorder after concussion characterized by periodic moderately sized myopic refractive error fluctuations without measurable other features of spasm of the near reflex.

Objectively document a class of accommodative dysfunction that may be related to concussion.

Case 1 involved two sports-related concussions 2 months apart with symptoms of headache and variable blur. Refractive stability was measured 28 months after injury with a binocular open-field refractometer documenting fluctuations from -0.25 to -1.75 D occurring 10 times during 4.2 seconds of recording with no evident miosis or convergent strabismus. The symptoms resolved with 1% atropine × 3 weeks. Case 2 involved a concussive blast injury (improvised explosive device) 7 years prior with symptoms of headache behind the eyes and occasional variable blur and reduced tolerance of electronic displays and other visually intensive tasks. Refractive fluctuations from +0.50 to -2.00 D occurred seven times over 44 seconds of recording with no appreciable miosis or change of interpalpebral fissure. The signs and symptoms were unresponsive to seven occupational therapy sessions involving task modifications and accommodative vision therapy activities.

In patients complaining of blurry vision, a careful evaluation of the stability of accommodation is indicated.