Accommodation spasm – the functional violation of sight caused by the long spastic reduction of a tsiliarny muscle continuing in conditions when focusing close is not required. The spasm of accommodation is followed by decrease in visual acuity afar, bystry exhaustion when performing visual work at a short distance, eyeball, temples pain, frontal area. The spasm of accommodation comes to light the ophthalmologist at comprehensive examination (a vizometriya, definition of a refraction and stocks of accommodation). Treatment of a spasm of accommodation includes hardware trainings, instillations of eye drops, physical therapy (an electrophoresis, magnetotherapy, laser therapy).
Accommodation spasm (false short-sightedness, syndrome of tired eyes) – the violation of a dezakkomodation (accommodation afar) caused by the recorded tension of a tsiliarny muscle. The spasm of accommodation is one of the most frequent diseases in children's ophthalmology taking the second place after short-sightedness. Statistically, 15% of children of school age suffer from a spasm of accommodation. Till a certain moment the spasm of accommodation is reversible, however is long nekorrigiruyemy false short-sightedness over time can pass into true short-sightedness at children.
Accommodation spasm mechanism
Accommodation is the mechanism providing focusing of a view of various distance. Normal this process is regulated by the coordinated work of the akkomodatsionny device including three anatomic interconnected an eye element – a tsiliarny muscle, tsinnovy ligaments and a crystalline lens. The Tsiliarny (akkomodatsionny) muscle is presented by three main portions of gladkomyshechny fibers: meridional (Bryukke's muscle), radial (Ivanov's muscle) and circular (Müller's muscle).
During accommodation afar (dezakkomodation) of a muscle are weakened. When focusing a look on nearby objects meridional fibers of a ciliary muscle strain, reduction of tsinnovy sheaves is weakened that is followed by increase in curvature of a crystalline lens and strengthening of a refraction of an eye. At an accommodation spasm the radial and circular fibers of a tsiliarny muscle which are dezakkomodatsionny on the function cannot relax fully. As a result the tsiliarny body is in a condition of permanent long reduction - an accommodation spasm.
Finding of a tsiliarny muscle in a condition of constant tension is followed by violation its blood supply and the risk factor of the subsequent development of horioretinalny dystrophy is.
Accommodation spasm reasons
The accommodation spasm in most cases develops at children, teenagers or young people that is connected with age features of the akkomodatsionny device. As the main reasons of a spasm of accommodation at school students the excessive visual loadings connected with long viewing of the TV, the work behind the monitor of the computer which is incorrectly picked up by educational furniture, reading at a short distance, bad lighting, influence approximately of too bright light, etc. act. Besides, development of a spasm of accommodation is promoted by an irrational day regimen of the child at which insufficient time is allowed to a dream, walks in the fresh air, physical activity and exercises for eyes. Among the reasons of the general character the adynamy, hypovitaminosis, vertebrobazilyarny insufficiency, violations of a bearing, juvenile osteochondrosis have the greatest value.
With age, approximately after 40-45 years, the crystalline lens is condensed and becomes less elastic that is followed by decline in the ability of good vision close, i.e. age weakening of accommodation - development of age far-sightedness (presbiopiya). Therefore the accommodation spasm at mature age happens seldom and is mainly again caused by such reasons as neurosis, hysteria, ChMT (a bruise or concussion), a climax, etc. Emergence of a spasm of accommodation can be promoted by the professional activity connected with small visual loading (work of the watchmaker, jeweler, embroideress, etc.).
Classification of a spasm of accommodation
Taking into account the reasons in ophthalmology it is accepted to allocate several types of a spasm of accommodation:
- Physiological (akkomodativny), arising as response to a visual overload, long visual work close at persons with nekorrigirovanny far-sightedness or an astigmatism. The physiological spasm of accommodation demands selection of-point correction and maintenance of a ciliary muscle.
- Artificial (tranzitorny), caused by effect of some eye medicines-miotikov (pilocarpine, a phosphastake, an ezerin, etc.). The artificial spasm of accommodation does not demand treatment, disappears independently after cancellation of miotik.
- The pathological spasm of accommodation which is followed by change of a refraction from gipermetropichesky and emmetropichesky to miopichesky and decrease in visual acuity. The pathological spasm of accommodation shares on resistant and unstable; fresh (less than 1 year) and old (more than 1 year); uniform and uneven.
In practice of ophthalmologists the mixed accommodation spasm combining physiological and pathological mechanisms is more often observed.
Accommodation spasm symptoms
As subjective manifestations of a spasm of accommodation deterioration in clearness of sight afar, doubling the feeling of gripes and burning in eyes, eyeball pain, temporal and frontal area can serve in eyes, bystry visual exhaustion from work close. Reddening of eyes and dacryagogue is often noted. Quite often the child shows uncertain complaints to a headache and fatigue; becomes irritable, it reduces school progress that can incorrectly be regarded as age reorganization of an organism. Duration of a spasm of accommodation can vary from several months to several years, quite often passing at children into persistent school short-sightedness.
The pathological spasm of accommodation is followed as eye symptoms (an anizokoriya, nistagmy, a tremor a century), and the general manifestations. At patients vegeto-vascular dystonia, emotional lability, decrease in mood, palms, a shiver of fingers of hands, migraine attacks can be noted.
Diagnostics and treatment of a spasm of accommodation
The child with complaints to visual exhaustion or decrease in sight has to be examined by the children's ophthalmologist. The algorithm of inspection of the child with suspicion on a spasm of accommodation includes definition of visual acuity, volume and a stock of accommodation, refractometry, a skiaskopiya, a convergence research. For identification of the possible reasons of a spasm of accommodation profound inspection at the pediatrician, the children's neurologist, the children's traumatologist-orthopedist, etc. can be recommended to the child. At diagnostics of a spasm of accommodation the complex treatment including hardware methods of treatment, medicamentous therapy, physiotherapy, improving and hygienic actions is appointed.
Medicinal therapy at a spasm of accommodation assumes instillations of the eye drops relaxing a tsiliarny muscle (a tropikamid, a fenilefrin), vitamin therapy. From physiotherapeutic techniques the electrophoresis and magnetotherapy is most often used. If backbone diseases act as the reason of a spasm of accommodation, medical massagethe course cervical zones and backs, acupunctures, manual therapy, physiotherapy exercises can be recommended to the patient.
For a training of a tsiliarny muscle the program and computer Relax module, an elektrookulostimulyation, magnetostimulation, a lazerstimulyation, a tsvetostimulyation are effective. In house conditions Sidorenko's points on doctor's orders can be applied (are recommended for children is more senior than 3 years). For fixing of effect of complex therapy of a spasm of accommodation the general improvement of an organism - a balanced diet, a hardening, sports activities, respect for hygiene of sight, performance of special gymnastics for eyes is extremely important.
Forecast and prevention of a spasm of accommodation
The spasm of accommodation is reversible functional frustration and will successfully respond to treatment. Medicamentous therapy quickly removes a spasm of a tsiliarny muscle due to its compulsory relaxation therefore achievement of resistant result requires carrying out a full complex of medical actions and elimination of the reasons which led to development of a spasm of accommodation. Early identification and treatment of a spasm of accommodation will allow to prevent development of short-sightedness in children.
Prevention of a spasm of accommodation includes the general improvement of an organism, frequent walks, good night rest, a balanced diet, exercises and sport. An important point is respect for sanitary and hygienic norms of visual work: good illumination of a workplace, the correct landing and a bearing, a sufficient distance in work with the monitor or the book, regular breaks and so forth. At far-sightedness or an astigmatism selection of optical correction (points, contact lenses), passing of courses of functional rehabilitation is necessary.