Methods and Effect of Management of Patients with Convergence Spasm and Aquired Pseudomyopia

Il Joo Kwon; Suk Gyu Ha; Seung Hyun Kim

doi:10.3341/jkos.2015.56.10.1630

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Kwon, Ha, and Kim: Methods and Effect of Management of Patients with Convergence Spasm and Aquired Pseudomyopia

Original Article

J Korean Ophthalmol Soc 2015;56(10):1630-1634.

Published online: 28 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1630

Methods and Effect of Management of Patients with Convergence Spasm and Aquired Pseudomyopia

Il Joo Kwon, M.D, Suk Gyu Ha, M.D, Seung Hyun Kim, M.D, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Seung Hyun Kim, MD, PhD Department of Ophthalmology, Korea University Anam Hospital, #73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: 82-2-920-5521, Fax: 82-2-924-6820 E-mail: ansaneye@hanmail.net

‗ This study was supported in part by Alumni of Department of Ophthalmology, Korea University College of Medicine in 2015.

Received 6 March 20159 April 2015 Accepted 3 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate changes in the degree of pseudomyopia and prognosis in patients with convergence spasm and acquired pseudomyopia.

Methods

The medical records of patients with convergence spasm and acquired pseudomyopia at the Korea University Medical Center from 2011 to 2014 were identified. We reviewed the patients’ gender, age, onset time, visual acuity, refractive error, angle of strabismic deviation and the selected management (cycloplegics, patching, cycloplegics + patching, prism glasses).

Results

At the first medical examination, the mean age was 20.08 years. The mean spherical equivalent was -3.75 diopter (D) in the right eye and -4.03 D in the left eye based on manifest refraction and -2.59 D in right eye and -2.85 D in left eye using cyclo-plegic refraction. Eleven of 12 patients had esodeviation with a mean esodeviation of 10.42 D. The pupil size was 3.63 mm in the right eye and 3.63 mm in the left eye. No patient experienced severe miosis (pupil size <2 mm). Observation (5), patching (3), cy-cloplegics (2), patching + cycloplegics (1) and prism (1) management were performed in 12 patients. Outcomes included com-pletely cured (3), improvement (7) and no change or recurrence (2).

Conclusions

Active management is necessary for patients with convergence spasm and acquired pseudomyopia. J Korean Ophthalmol Soc 2015;56(10):1630-1634

Keywords: Accommodative spasm, Convergence spasm, Near reflex spasm, Pseudomyopia

References

1. Goldstein JH, Schneekloth BB. Spasm of the near reflex: a spec-trum of anomalies. Surv Ophthalmol. 1996; 40:269–78.

2. Cogan DG, Freese CG Jr. Spasm of the near reflex. AMA Arch Ophthalmol. 1955; 54:752–9.

3. Griffin JF, Wray SH, Anderson DP. Misdiagnosis of spasm of the near reflex. Neurology. 1976; 26:1018–20.

4. Sollom AW. Unilateral spasm of accommodation and transient convergent squint due to an anxiety neurosis. Br Orthopt J. 1966; 23:118–9.

5. Yang YR, Koh JW, Choi NY, Park SC. A Study of patients with spasm of the near reflex. J Korean Ophthalmol Soc. 2006; 47:1630–7.

6. Kim SJ, Lee JB, Kwak YS. A case of hysterical convergence spasm. J Korean Ophthalmol Soc. 1982; 23:817–21.

7. Rutstein RP, Daum KM, Amos JF. Accommodative spasm: a study of 17 cases. J Am Optom Assoc. 1988; 59:527–38.

8. Fitzgerald CE. Acute spasm of the accommodation. Trans Ophthalmol Soc UK. 1884; 4:311–5.

9. Keane JR. Neuro-ophthalmic signs and symptoms of hysteria. Neurology. 1982; 32:757–62.

10. Rutstein RP, Galkin KA. Convergence spasm-two case reports. J Am Optom Assoc. 1984; 55:495–8.

11. Souders BF. Hysterical convergence spasm. Archives of Ophthalmology. 1942; 27:361–5.

12. Sloane AE, Kraut JA. Spasm of accommodation. Doc Ophthalmol. 1973; 34:365–9.

13. Daum KM. Accommodative dysfunction. Doc Ophthalmol. 1983; 55:177–98.

14. Burian HM. Motility clinic: intermittent (facultative) divergent strabismus. Its influence on visual acuity and the binocular visual acuity and the binocular visual act. Am J Ophthalmol. 1945; 28:525–7.

15. Seaber JH. Pseudomyopia in exodeviations. Am Orthopt J. 1966; 16:67–72.

16. Schwartze GM, McHenry LC Jr, Proctor RC. Convergence spasm- treatment by amytal interview. A case report. J Clin Neuroophthalmol. 1983; 3:123–5.

Table 1.

Clinical characteristics and course in patients

No.	Sex	Age (years)	Onset	Symptom	Angle of deviation		Management F	Duration of F/U (months)	Course (last F/U)	Remark
No.	Sex	Age (years)	Onset	Symptom	Disatant (PD)	Near (PD)	Management F	Duration of F/U (months)	Course (last F/U)	Remark
1	M	33	Acute	Diplopia	12 LET	12 LET	Patch + cycloplegics	2	Improvement
2	F	9	Acute	Blurred vision, diplopia	Ortho	Ortho	Patch	1	Complete cure
3	M	18	Acute	Diplopia	14 ET	14 ET	Observation	4	Improvement
4	M	33	Acute	Diplopia	6 E	6 E	Observation	1	Improvement
5	M	31	Acute	Diplopia	18 LET	18 LET	Observation	1	Improvement
6	M	28	Insidious	Diplopia	8 E	8 E	Patch	2	Improvement
7	M	18	Insidious	Diplopia	Ortho	18 RET	Prism	34	No change
8	F	12	Acute	Diplopia	10 ET	10 ET	Cycloplegics	24	Improvement	BMR rec
9	M	16	Acute	Diplopia	25 LET	25 LET	Observation	8	Improvement	RMR rec
10	F	15	Acute	Diplopia, dizziness	8 E	8 E	Patch	27	Complete cure
11	M	20	Insidious	Blurred vision, diplopia	6 E	6 E	Cycloplegics	16	Complete cure
12	F	8	Acute	Blurred vision	8 E	8 E	Cycloplegics PY consult (high stress level)	12	Improvement but recurrence

PD = prism diopter; F/U = follow up; LET = left esotropia; Ortho = orthophoria; ET = esotropia; E = exophoria; RET = right esotropia; BMR = both medial rectus; rec = recession; RMR = right medial rectus; PY = psychiatry.

Table 2.

Visual acuity and refractive error

Patients	Corrected visual acuity	Initial refractive error		Final refractive error
Patients	Corrected visual acuity	Manifest refraction	Cycloplegic refraction	Manifest refraction
1	RE 0.8	-3.00 Dsph: -0.75 Dcyl Axis 163°	-1.50 Dsph	-1.75 Dsph: -0.25 Dcyl Axis 156°
	LE 0.8	-2.75 Dsph: -0.75 Dcyl Axis 63°	-1.50 Dsph	-1.75 Dsph: -0.25 Dcyl Axis 11°
2	RE 0.6	-1.25 Dsph: -0.25 Dcyl Axis 172°	+2.50 Dsph: -1.00 Dcyl Axis 180°	-1.50 Dsph
	LE 0.7	-0.75 Dsph	+0.50 Dsph: -1.00 Dcyl Axis 180°	-0.25 Dsph
3	RE 1.0	-5.25 Dsph	-5.50 Dsph	-5.50 Dsph: -2.00 Dcyl Axis 6°
	LE 1.0	-5.25 Dsph	-5.50 Dsph	-5.25 Dsph: -1.25 Dcyl Axis 9°
4	RE 1.0	-3.00 Dsph: -0.75 Dcyl Axis 166°	-3.00 Dsph	-3.00 Dsph
	LE 1.0	-4.25 Dsph	-3.00 Dsph	-3.00 Dsph
5	RE 1.0	-1.75 Dsph	-1.50 Dsph	-1.50 Dsph
	LE 1.0	-1.50 Dsph: -0.75 Dcyl Axis 161°	-1.50 Dsph	-1.50 Dsph
6	RE 0.9	-7.00 Dsph: -2.00 Dcyl Axis 178°	-6.50 Dsph	-5.50 Dsph: -2.75 Dcyl Axis 174°
	LE 1.0	-6.50 Dsph: -2.25 Dcyl Axis 10°	-6.00 Dsph	-5.50 Dsph: -2.75 Dcyl Axis 20°
7	RE 0.8	-4.75 Dsph: -1.50 Dcyl Axis 170°	-4.50 Dsph: -1.50 Dcyl Axis 180°	-4.25 Dsph: -2.50 Dcyl Axis 12°
	LE 1.0	-4.75 Dsph: -1.50 Dcyl Axis 180°	-4.50 Dsph: -1.50 Dcyl Axis 180°	-4.25 Dsph: -0.75 Dcyl Axis 4°
8	RE 1.0	-4.00 Dsph	-1.50 Dsph: -0.25 Dcyl Axis 164°	-2.00 Dsph: -0.75 Dcyl Axis 101°
	LE 1.0	-2.50 Dsph: -0.50 Dcyl Axis 59°	-1.25 Dsph: -0.50 Dcyl Axis 1°	-1.75 Dsph
9	RE 1.0	-0.25 Dsph: -0.75 Dcyl Axis 98°	Plano: -0.50 Dcyl Axis 90°	Plano
	LE 1.0	-0.25 Dsph: -1.00 Dcyl Axis 76°	Plano: -0.50 Dcyl Axis 90°	Plano
10	RE 1.0	-5.75 Dsph: -0.50 Dcyl Axis 7°	-5.50 Dsph	-5.50 Dsph
	LE 1.0	-6.25 Dsph: -0.50 Dcyl Axis 173°	-5.50 Dsph	-6.50 Dsph
11	RE 1.0	-4.25 Dsph	-3.00 Dsph	-3.00 Dsph: -1.00 Dcyl Axis 175°
	LE 1.0	-8.50 Dsph: -2.50 Dcyl Axis 130°	-3.00 Dsph	-3.00 Dsph: -0.75 Dcyl Axis 13°
12	RE 1.0	-1.50 Dsph	Plano	-1.50 Dsph
	LE 1.0	-1.50 Dsph	Plano	-1.50 Dsph

RE = right eye; LE = left eye; D = diopter; sph = sphere manifested refraction; cyl = cylinder manifested refraction.

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