Spasm of the Near Reflex

Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls

“…While some draw distinction between the near reflex and isolated esotropia or pseudo-sixth nerve palsy,21 others conclude that accommodative spasm may consist of pseudomyopia with or without esodeviation or miosis 3. Although none of our patients had any spontaneous complaints that could be attributed to convergence spasm, during the manoeuvre designed to elicit the sign many patients complained of blurred vision, diplopia, headaches and eye pain, also reported by others 1 19. Convergence spasm is often misdiagnosed as sixth nerve palsy,20 but the presence of miosis helps establish the diagnosis of convergence spasm.…”

“…Other authors have considered convergence spasm to be a frequent psychogenic sign,1 12–18 with 86% female predominance in one study 19. Described by von Graefe in 185615 in two cases of ‘acute spasm of accommodation’, a link between this neuro-ophthalmologic sign and hysteria dates back to the early 20th century when ‘spastic hysterical convergent strabismus’ was reported by Knapp in 1918 12.…”

Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls

“…While some draw distinction between the near reflex and isolated esotropia or pseudo-sixth nerve palsy,21 others conclude that accommodative spasm may consist of pseudomyopia with or without esodeviation or miosis 3. Although none of our patients had any spontaneous complaints that could be attributed to convergence spasm, during the manoeuvre designed to elicit the sign many patients complained of blurred vision, diplopia, headaches and eye pain, also reported by others 1 19. Convergence spasm is often misdiagnosed as sixth nerve palsy,20 but the presence of miosis helps establish the diagnosis of convergence spasm.…”

“…Other authors have considered convergence spasm to be a frequent psychogenic sign,1 12–18 with 86% female predominance in one study 19. Described by von Graefe in 185615 in two cases of ‘acute spasm of accommodation’, a link between this neuro-ophthalmologic sign and hysteria dates back to the early 20th century when ‘spastic hysterical convergent strabismus’ was reported by Knapp in 1918 12.…”

Case Series: Periodic Accommodative Fluctuations after Concussion

“…The objective data presented here were consistent with the subjective reports of rapidly fluctuating clarity of vision and provide evidence for the existence of an accommodative disorder after traumatic brain injury characterized by periodic (occurring at a regular interval) moderately sized myopic refractive error fluctuations. The lack of a substantial miosis or convergent strabismus during the events distinguished this clinical entity from more striking and severe spasm of the near reflex, 3 which is better described as intermittent and sporadic, not periodic. The size of the refractive fluctuations in our cases is moderate, being less than larger fluctuations reported in some cases of spasm of the near reflex (reported as high as −7.00 D) 4 and distinctly larger than the <0.25 D normal accommodative oscillations 5 .…”

Efficacy and safety of acupuncture for patients with pseudomyopia

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred. [2] The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops. [22,23] Pseudomyopia will gradually develop into true myopia or even high myopia, high myopia is associated with an increased risk of developing sight-threatening conditions such as myopic macular degeneration (defined as atrophic changes or choroidal neovascularization in the macular region in high myopia), retinoschisis, posterior staphyloma, glaucoma retinal detachment, and cataract.…”

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred [2] . The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops [22,23] .…”

Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls

“…While some draw distinction between the near reflex and isolated esotropia or pseudo-sixth nerve palsy,21 others conclude that accommodative spasm may consist of pseudomyopia with or without esodeviation or miosis 3. Although none of our patients had any spontaneous complaints that could be attributed to convergence spasm, during the manoeuvre designed to elicit the sign many patients complained of blurred vision, diplopia, headaches and eye pain, also reported by others 1 19. Convergence spasm is often misdiagnosed as sixth nerve palsy,20 but the presence of miosis helps establish the diagnosis of convergence spasm.…”

“…Other authors have considered convergence spasm to be a frequent psychogenic sign,1 12–18 with 86% female predominance in one study 19. Described by von Graefe in 185615 in two cases of ‘acute spasm of accommodation’, a link between this neuro-ophthalmologic sign and hysteria dates back to the early 20th century when ‘spastic hysterical convergent strabismus’ was reported by Knapp in 1918 12.…”

Case Series: Periodic Accommodative Fluctuations after Concussion

“…The objective data presented here were consistent with the subjective reports of rapidly fluctuating clarity of vision and provide evidence for the existence of an accommodative disorder after traumatic brain injury characterized by periodic (occurring at a regular interval) moderately sized myopic refractive error fluctuations. The lack of a substantial miosis or convergent strabismus during the events distinguished this clinical entity from more striking and severe spasm of the near reflex, 3 which is better described as intermittent and sporadic, not periodic. The size of the refractive fluctuations in our cases is moderate, being less than larger fluctuations reported in some cases of spasm of the near reflex (reported as high as −7.00 D) 4 and distinctly larger than the <0.25 D normal accommodative oscillations 5 .…”

Efficacy and safety of acupuncture for patients with pseudomyopia

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred. [2] The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops. [22,23] Pseudomyopia will gradually develop into true myopia or even high myopia, high myopia is associated with an increased risk of developing sight-threatening conditions such as myopic macular degeneration (defined as atrophic changes or choroidal neovascularization in the macular region in high myopia), retinoschisis, posterior staphyloma, glaucoma retinal detachment, and cataract.…”

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred [2] . The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops [22,23] .…”

Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls

“…While some draw distinction between the near reflex and isolated esotropia or pseudo-sixth nerve palsy,21 others conclude that accommodative spasm may consist of pseudomyopia with or without esodeviation or miosis 3. Although none of our patients had any spontaneous complaints that could be attributed to convergence spasm, during the manoeuvre designed to elicit the sign many patients complained of blurred vision, diplopia, headaches and eye pain, also reported by others 1 19. Convergence spasm is often misdiagnosed as sixth nerve palsy,20 but the presence of miosis helps establish the diagnosis of convergence spasm.…”

“…Other authors have considered convergence spasm to be a frequent psychogenic sign,1 12–18 with 86% female predominance in one study 19. Described by von Graefe in 185615 in two cases of ‘acute spasm of accommodation’, a link between this neuro-ophthalmologic sign and hysteria dates back to the early 20th century when ‘spastic hysterical convergent strabismus’ was reported by Knapp in 1918 12.…”

Case Series: Periodic Accommodative Fluctuations after Concussion

“…The objective data presented here were consistent with the subjective reports of rapidly fluctuating clarity of vision and provide evidence for the existence of an accommodative disorder after traumatic brain injury characterized by periodic (occurring at a regular interval) moderately sized myopic refractive error fluctuations. The lack of a substantial miosis or convergent strabismus during the events distinguished this clinical entity from more striking and severe spasm of the near reflex, 3 which is better described as intermittent and sporadic, not periodic. The size of the refractive fluctuations in our cases is moderate, being less than larger fluctuations reported in some cases of spasm of the near reflex (reported as high as −7.00 D) 4 and distinctly larger than the <0.25 D normal accommodative oscillations 5 .…”

Efficacy and safety of acupuncture for patients with pseudomyopia

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred. [2] The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops. [22,23] Pseudomyopia will gradually develop into true myopia or even high myopia, high myopia is associated with an increased risk of developing sight-threatening conditions such as myopic macular degeneration (defined as atrophic changes or choroidal neovascularization in the macular region in high myopia), retinoschisis, posterior staphyloma, glaucoma retinal detachment, and cataract.…”

“…Pseudomyopia is caused by the continuous contraction and spasm of the ciliary muscle due to excessive use of the eye, the thickness of the lens increases, and the vision is blurred [2] . The prevalence of pseudomyopia is reported as approximately 24% in 6-year-olds and 18% in 13-year-olds and is likely to increase further given the amount of time spent by children and adults on electronic devices such as smartphones, tablets, and laptops [22,23] .…”