accomodation , anomalies , ill-sustained accomodation , inertia of accomodation , fatigue of accomodation etc

1. Accommodation and
it's Anomalies
By,
Ayushi Patel
3rd year of optometry

2. Accommodation
The ability of crystaline lens to
increase it's convexcity with the
help of constriction of ciliary
muscle and relexation of the
zonules to see the clear image.

5. Near point or punctum proximum
The nearest point at which small object can be
seen clear.

6. Far point or punctum remotum
The farthest point at which small
objects can be seen clear.
 Hypermetropic :- far point behind the
eye.
Myopoic :- far point front of the eye.
Emmetropic :- far point at infinity

7. • The distance between
far point and near point.
• a= r - p
Range of
Accommodation
Amplitude of
Accommodation
• The difference between
dioptric power , needed
to focus at near point to
far point.
• A = P - R.

10. Presbyopia

12. Causes of presbyopia
1 ) Age related changes : - Decrease elasticity of lens capsule.
progressive increase in size and hardness in
the lens.
2) pre mature presbyopia:- uncorrected hypermetropia
presenile weakness of ciliary muscle
chronic simple glaucoma
wekning of ciliary muscle power
premature sclerosis.

13. Symptoms
• difficulty in near vision
• Asthenopic symptoms
• Intermittent diplopia

14. Treatment
• Prescribe near vision addition according to
age or patient's need.
• Single vision reading glasses, bifocal , trifocal
and multifocal.
• Always find out distance refractive error first
and correct it.

15. Insufficiency of
accommodation
According to age accommodation is poor.
"premature presbyopia"

16. Causes
• Premature sclerosis of lens.
• Weakness of ciliary muscles ,
• Due to systemic causes :- Malnutrition ,
• Pregnancy , DM , MS
• Due to local cause : - Primary open angle
glaucoma,
• Mild cyclitis

17. Symptoms
• Headache , Fatigue , Near vision
blur
• Over and under convergence
• Intemittent diplopia

19. Treatment
• Treat the causes
• Spectecle correction :-
• For near weakest convex lens prescribe
• For Convergence insufficiency base out prism
prescribe
• For excessive convergence full sph correction
prescribe
• Accommodative exercise :- vision therapy (flippers)
• Take proper food nutrition

20. ILL-SUSTAINED
ACCOMMODATION
 It is the condition in which the range of
accommodation is normal but it cannot be
sustained for proper time period.
 Eye fatigue produced when do long time near
work .
 NPA is recede during close work.

21. Etiology :- Accommodative fatigue
Debiliting illness
Symptom :-
Feeling tired very
soon while doing
near work.

22. Accommodation Inertia
 Difficulty in changing focus from
distance to near vision .
It takes some more time to clear the
distance object after looking the near
object.

23. Etiology Treatment
• Prolong close
work and occular
motor imbalance
• Correct
refractive error
• Do
accommodative

24. Paralysis of
Accommodation
complete absence of
accommodation
also known as cycloplegia.

25. Causes
• Drug induced myopia : -
atropine,homatropine
• Internal ophthalmoplegia
• 3rd nerve paralysis
• paralysis of accommodation
• head injury

26. Symptoms
• blurring of near vision.
• photophobia
• micropsia
• 3rd nerve palsy
• abnormal receding of near point

27. Treatment
• self recovery of drug induced cycloplegia.
• Dark glasses for photophobia
• convex lens for near vision correction.

28. Excessive Accommodation
• when accommodation efforts more than normal for
near work.
• CAUSES : - young hypermetropes
• young myopes
• astigmatic error
• presbyopes in the begining
• inproper ill fitting spectacles
• FACTOR : - A large number of near work

29. Symptoms
• varying degree of blurred vision
• headaches, fatigue,discomfort in eyes
• near vision difficulty
• macropsia
• miosis
• far point and near point both are brought nearer to
the eyes.

30. Treatment
• optical : - cyclopegic refraction (RE should be corrected)
• General : -

31. Spasm of Accommodation
Abnormal excessive accommodation which is out of the voluntary
control of the individual.
CAUSES : - drug induced spasm of accommodation
spontaneous SOA - uncorrected hypermetropia
astigmatism and myopia
bad illumination , bed reading
iridocyclitis , spasm of near reflex , lesions of brsinstem
toxic reaction of exogenous poisons

32. Symptoms
• blurred vision due to induced
pseudomyopia
• asthenopic symptoms > visual
symptoms
• headache,browache
• near point is close

33. Treatment
• Relaxation of ciliary muscle :- cycloplegia for
long time
• optical : -
• correcting spectacles should be worn
immidiately when eyes are used again