Accommodative Spasm Presenting as Pseudomyopia in a 47-Year-Old Male With Headache as the Primary Complaint: A Case...

Pseudomyopia refers to an apparent myopic shift caused by accommodative overactivity that resolves after cycloplegia and may occur as an isolated accommodative spasm or within the broader spasm of the near-reflex spectrum. Because the refractive component is functional rather than structural, cycloplegic refraction is essential to confirm reversibility and avoid misclassification as true myopia. A 47-year-old male police officer presented with a 1-month history of persistent, dull headaches associated with ocular discomfort. Symptoms were accompanied by intermittent nausea and visual strain, more pronounced during prolonged near tasks and smartphone use. Prior to an ophthalmologic assessment, he underwent a comprehensive neurological evaluation at a local hospital, including a computed tomography scan of the brain, which revealed no intracranial abnormalities. Cycloplegic refraction was performed in a staged manner across two visits due to occupational and driving requirements. At the initial visit, pre-cycloplegic autorefraction of the left eye demonstrated -0.75 -0.75 × 159° OS, with post-cycloplegic refraction of +1.25 -1.00 × 165° (+1.87 D hyperopic shift). At the two-week follow-up, pre-cycloplegic autorefraction of the right eye demonstrated plano -1.50 × 9° OD, with post-cycloplegic refraction of +1.75 -1.50 × 8° (+1.75 D hyperopic shift), suggesting a bilateral accommodative spasm. Near-addition spectacle correction was prescribed, and the patient was advised to limit prolonged near work, implement the 20-20-20 rule, and optimize workplace ergonomics. Cycloplegic refraction remains central to the diagnosis of accommodative spasm and pseudomyopia, and a marked shift toward reduced myopia or hypermetropia after cycloplegia supports the diagnosis. In this patient, optical management with near-addition correction was preferred over pharmacologic cycloplegia because of occupational and driving requirements.