Accommodative excess


In ophthalmology, accommodative excess occurs when an individual uses more than normal accommodation for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patient's age. Modern definitions simply regard it as an inability to relax accommodation readily. Excessive accommodation is seen in association with excessive convergence also.

Symptoms and signs

The presentation is as follows:

Causes

Causes related to [refractive errors]

Accommodative excess may be seen in the following conditions:Hypermetropia: Young hypermetropes use excessive accommodation as a physiological adaptation in the interest of clear vision.Myopia: Young myopes performing excessive near work may also use excessive accommodation in association with excessive convergence.Astigmatism: Astigmatic eye may also be associated with accommodative excess.Presbyopia: Early presbyopic eye may also induce excessive accommodation.Improper or ill fitting spectacles: Use of improper or ill fitting spectacles may also cause use of excessive accommodation.

Causes related to systemic drugs

Use of systemic drugs like Morphine, Digitalis, Sulfonamides, Carbonic anhydrase inhibitors may cause accommodative excess.

Causes related to diseases

Secondary to Convergence insufficiency

Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV.

Risk factors

A large amount of near work is the main precipitating factor of accommodative excess.

Pseudomyopia

Pseudomyopia also known as artificial myopia refers to an intermittent and temporary shift in refractive status of the eye towards myopia. It may occur due to excessive accommodation or spasm of accommodation.

Diagnosis

Differential diagnosis

Parinaud's syndrome, which can mimic some aspects of spasm of the near reflex, such as excessive accommodation and convergence; however, pupillary near-light dissociation, not miosis, is a feature of Parinaud's syndrome.

Treatment