Accommodation paralysis – frustration at which because of violations of a refraction it is temporarily impossible to change optical installation of an eyeball. Clinical manifestations include decrease in visual acuity close, the increased visual fatigue, difficulties of concentration of a look when examining of close located objects. Diagnostics is based on carrying out computer refractometry, a vizometriya, a research of akkomodatsionny ability of eyes. In treatment holinomimetik or antagonists of a-adrenoceptors can be used. When traumatizing a pupillary sphincter or tsiliarny muscle expeditious treatment is shown.
Accommodation paralysis – which quite seldom meets in ophthalmology. Pathology is most widespread among children of 7-15 years, is less often diagnosed for people of middle and old age. According to statistical data, in 60-70% of cases application of tsikloplegik is the cornerstone of the mechanism of development of a disease. At infections violation of akkomodatsionny ability can be considered as the passing phenomenon. Prevalence in the general structure of ophthalmologic diseases is not studied. Persons men's and female suffer with an identical frequency. Akkomodatsionny frustration are widespread everywhere.
Accommodation paralysis reasons
It is considered that the disease can be provoked by a psychoemotional overstrain. Scientists study interrelation between emergence of symptoms and metabolic frustration at diabetes. The temporary paralytic phenomena are observed at sharp alcoholic intoxication. At patients with chronic alcoholism both eyes are affected symmetrically. The list of the main reasons for pathology includes:
- Infectious diseases. Paralysis of accommodation it becomes frequent one of displays of botulism, is caused by toxic influence of a botulotoksin. Bilateral defeat also comes to light at patients with diphtheria, syphilis and flu.
- Application of tsikloplegik. The passing symptomatology develops at instillation in conjunctival cavity M-holinolitikov (atropine). Frequent use of medicines of this group can lead to irreversible expansion of a pupil.
- Traumatic damages. Emergence of symptoms is connected with the direct or mediated traumatic injury of a tsiliarny muscle at a craniocereberal trauma. Frustration is often observed at an eye contusion.
- Brain diseases. Persistent visual dysfunction can demonstrate formation of formations of a brain (a tumor, a cyst, abscess). The clinic of passing paralysis is characteristic of meningitis or an encephalomeningitis.
- Yatrogenny intervention. Manifestations arise at injury of tsiliarny nerves during laser coagulation of a retina. Becomes a trigger factor lazero-or electrostimulation of a ciliary muscle. In rare instances paralysis is a complication of a local baroterapiya.
Paralysis of accommodation develops because of the direct or mediated damage of a ciliary muscle and a sphincter of a pupil. Both structures are innervated by parasympathetic nervous fibers from tsiliarny knot. It explains the fact that binocular frustration is diagnosed at externally intact eyeball. At monocular option akkomodatsionny dysfunction which is also called "accommodation inequality" is observed. The reason of its emergence consists in direct damage of a ciliary muscle or pupillary sphincter.
Accommodation paralysis symptoms
Pathology demonstrates sharply or . Patients often connect emergence of symptomatology with a stress, infectious diseases or application of eye drops. There are complaints to the expressed deterioration in sight close, is very rare – in the distance. The impossibility to perform habitual visual work (reading, the letter, viewing of the TV) at a short distance, to concentrate a look on one subject becomes the reason of the address to the ophthalmologist. Patients accurately specify time of development of the first symptoms. More often sight decreases symmetrically, however cases of unilateral defeat are described. The disease is inclined to a recidivous current. If damage of a brain becomes the reason, in a clinical picture the meningealny symptomatology presented by nausea, unrestrained vomiting, a severe headache dominates.
Diagnosis is based on data of the anamnesis, objective survey and results of tool techniques. Visually one comes to light - or bilateral expansion of pupils. At an injury of a tsiliarny muscle the centers of subconjunctival hemorrhage are visible. Other changes from a forward segment of an eyeball are not found. Specific methods of diagnostics are:
- Computer refractometry. The emmetropichesky or gipermetropichesky type of a clinical refraction is defined. At a gipermetropiya the divergence of vertical and horizontal axes is noted.
- Vizometriya. When carrying out correction visual acuity afar remains high, is rare – decreases. Close decrease to 0,1 is confirmed below. At auxiliary use of convex glasses sight improves.
- Accommodation research. Use standard sets of negative and positive lenses. To study the volume of akkomodatsionny ability of an eyeball it is impossible as the closest point of clear sight merges from further.
Differential diagnostics is performed with weakness of accommodation and a presbiopiya. At weakness of accommodation patients cannot accurately designate time frames of emergence of the first symptoms, the sharp demonstration is characteristic of paralysis. At a presbiopiya clinical manifestations develop in mature or old age. Their expressiveness increases gradually that atypically for paralysis.
Treatment of paralysis of accommodation
Often therapy does not render due effect, paralysis is spontaneously leveled for 2-3 months. Visual acuity is restored spontaneously. Tactics of maintaining the patient is strictly individual, is defined by a disease etiology. At a medicamentous origin of pathology visual functions are normalized after completion of pharmacological action of a tsikloplegik or influence of bacterial and virus toxins. It is possible to accelerate process by instillations in a cavity of a conjunctiva of medicines on the basis of a foxglove glycoside. In the absence of effect application of holinomimetik or antagonists of a-adrenoceptors is shown. At traumatic ruptures of a tsiliarny muscle or sphincter surgical treatment which comes down to comparison of edges in the conditions of a clinical midriaz is recommended.
Forecast and prevention
In most cases the forecast at accommodation paralysis favorable. After the end of action of pathogenic factors (toxins, medicines) visual acuity is completely restored. If pathologies are the cornerstone organic damages of a sphincter of a pupil and a tsiliarny muscle, development of a gipermetropiya is possible. Miopiya never becomes a disease outcome. Specific preventive measures are not developed. Nonspecific prevention comes down to the prevention of uncontrolled application of eye drops. Patients with infectious diseases (botulism, flu, diphtheria) are surveyed at the ophthalmologist.