spasm of accommodation
Spasm of accommodation is a ciliary muscle spasm that produces excess accommodation.1 The accommodative system overaccommodates for the stimulus, and distance vision is usually impaired.1 Spasms as great as 25 D have been reported.1
Spasm of accommodation is most often secondary to constant parasympathetic innervation as part of the spasm of the near reflex.1 Its origin is usually not serious organic disease, although cases have been associated with LASIK, multiple sclerosis and closed head injury.1 For most patients the cause is probably psychogenic.1 Some clinicians use the term accommodative excess interchangeably with accommodative spasm.1
Occasionally the spasm produces pseudomyopia, usually of low degree but as high as 10 D.2 When myopia appears in a young patient with high esophoria, a cycloplegic examination should test for spasm.2
More detail
Treatment begins with plus lenses.1 Lenses alone rarely eliminate the spasm, so vision therapy to relax accommodation is added, and a short course of a cycloplegic agent is the next step if vision therapy fails.1 The goal is to eliminate the spasm along with the need for cycloplegia or plus lenses.1
Sources (7)
- Care of the Patient with Accommodative and Vergence Dysfunction (AOA guideline)
- Pickwell's Binocular Vision Anomalies, ch. 7
- American Optometric Association. Clinical Practice Guideline: Care of the Patient with Accommodative and Vergence Dysfunction.
- Grosvenor, T. 2007. Primary care optometry. 5th ed. St. Louis: Butterworth-Heinemann Elsevier.
- Rutstein, R. and Daum, K. 1997. Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
- Scheiman, M. and Wick, B. 2014. Clinical management of binocular vision: heterophoric, accommodative, and eye movement disorders. 4th ed. Philadelphia: Lippincott Williams & Wilkins.
- Yanoff, M. and Duker, J.S. eds. 2018. Ophthalmology. 5th ed. Edinburgh: Elsevier.
Reviewed October 2026