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Case Report

Functional spasm of accommodation: Changes on

scheimpflug imaging
Jaspreet Sukhija, Mangat R. Dogra, Thara Zadeng, Jagat Ram
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Spasm of accommodation is a rare condition
characterized by a sudden increase in myopia. It can
occur in emmetropes, hypermetropes and myopes.
All the physiological changes that occur in normal
accommodation are exaggerated. Mostly the cause is
functional disorder and the condition gradually improves.
We hereby present the changes occurring in spasm of
accommodation as seen on Scheimpflug imaging.
Keywords: Accommodation spasm, myopia, pentacam

Introduction At presentation to us on the third day of her symptoms, visual

Spasm of accommodation is characterized by intermittent and
usually painful convergence, accommodation, and miosis in
varying combinations with variable amount of time.[1] Various
etiologies have been implicated, including functional spasm of
oculo-motor muscle, hysterical convergence spasm and emotional
distress.[2] The excessive accommodative tone usually causes
pseudomyopia.[3] We herein report scheimpflug imaging in a
patient with spasm of accommodation.
Case Report
A 17-year-old girl complained of sudden onset blurring of vision
in both eyes following prolonged reading under a dim light. It was
associated with mild headache and eye strain. She was a known
case of myopia. Her refractive error was –2 diopters in both eyes.
Her records showed that her refractive error increased to –4
dioptre sphere on the day of her complaint and she was prescribed
spectacles on the same day. She was on salbutamol inhaler for
bronchial asthma.
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acuity was 6/36 and 6/24 in the right and the left eye with –4
dioptre spherical correction which she was wearing in both
eyes. BCVA (Best corrected visual acuity) was 6/6 with manifest
refraction of –7 diopter sphere OD and – 7.5/–0.5 × 70 OS.
Anterior segment examination revealed miosis, shallow anterior
chamber in both eyes. Intra-ocular pressure on applanation
tonometry was 14 and 16 mmHg in right and left eye, respectively.
On Pentacam examination after dilatation with phenylepherine 5%
drops, the anterior chamber depth was 1.64 mm OD and 1.57 mm
OS. The crystalline lens thickness was 4.01 mm in the right eye
and 4 mm in the left eye and the distance between the cornea
and posterior pole of the lens was 5.65 mm OD and 5.57 mm OS
[Figure 1a and 1b]. Cycloplegic refraction under cyclopentolate 1%
done 1 day later showed –1.5 dioptre sphere in the right and –1.75
dioptre sphere in the left eye and visual acuity of 6/6 OU. At this
time scheimpflug imaging showed an anterior chamber depth of
2.98 mm OD and 2.95 mm OS with a lens thickness of 3.7 mm in
the right eye and 3.62 mm in the left eye and the distance between
the cornea and posterior pole of the lens was 6.68 mm OD and
6.57 mm OS [Figure 2a and 2b]. No supraciliary effusion could
be documented on ultrasound biomicroscope. A diagnosis of
accommodative spasm was thus made clinically and morphological
changes were documented by pentacam. The patient was put on
cyclopentolate 1% drops once a day.

Discussion
DOI:
10.4103/0974-620X.142601
Accommodative spasm is a condition where there is an
involuntary, sustained accommodation in the absence of an

Copyright: © 2014 Sukhija J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence:
Dr. Jaspreet Sukhija, Assistant Professor, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
E-mail: jaspreetsukhija@rediffmail.com

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Sukhija, et al.: Spasmaccomodationpentacam

a b
Figure 1: (a) Scheimpflug image of the right eye during accommodative spasm after dilatation with phenylepherine 5% drops objectively reveals shall anterior chamber along with
lenticular parameters. (b) Scheimpflug image of the left eye showing a similar picture

a b
Figure 2: (a) Scheimpflug image of right eye after dilatation with cyclopentolate 1% drops. Note the increase in the anterior chamber depth with a decrease in lens thickness and
posterior movement of the crystalline lens. (b) Scheimpflug image of the left eye with similar findings

accommodative stimulus. The anterior lens becomes more sharply
curved, moving closer to the cornea.[4] Baikoff et al. analyzed the
anterior segment changes during accommodation using optical
coherence tomography (OCT).[5] They found that the anterior
pole of crystalline lens moves forward during accommodation and
there is a linear relationship between this movement and anterior
radius of curvature. Accordingly the posterior curvature decreased
proportionally. Controversy still exists as to the movement of the
posterior lenticular surface during accommodation. Recent study
by Strenk et al. reported no movement of the posterior lenticular
surface during accommodation whereas Bolz et al. have showed
posterior movement.[6,7] Koretz et al. showed that in young adults
the posterior lens surface may tend to move posteriorly a short
distance as well, so that total anterior segment length may increase
slightly whereas in adults this surface moves forward adding to the
decrease in anterior chamber depth.[4] Tsorbatzoglou et al. found
by partial coherence interferomtery that the decrease in ACD was
greater than the increase in anterior segment length (ASL) and thus

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Sukhija, et al.: Spasmaccomodationpentacam
hypothesized that the crystalline lens move forward simultaneously
during accommodation.[8] Dubbelman et al. found significant
anterior movement of the human lens during accommodation.[9] In
our young patient we observed forward movement of the posterior
lenticular surface as well. It may be hypothesized that this anterior
movement of the posterior surface of the crystalline lens occurs
in accommodative spasm which contributes to the increase in
accommodative amplitude. A myopic patient will appear to be
more myopic, a hyperopic patient will appear to be less hyperopic
and an emmetropic patient will appear to be a myopic.
Scheimpflug imaging is an important tool in objectively
quantifying the changes in accommodative spasm.
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Cite this article as: Sukhija J, Dogra MR, Zadeng T, Ram J. Functional spasm
of accommodation: Changes on scheimpflug imaging. Oman J Ophthalmol
2014;7:150-2.
Source of Support: Nil, Conflict of Interest: None declared.
Oman Journal of Ophthalmology, Vol. 7, No. 3, 2014