Accommodation is the ability of an organism or organ to adapt to any circumstances.
The concept of accommodation, as a rule, is used to reflect the pathologies of the diopter power of the visual ophthalmological system, i.e., in order to accurately establish objects that are noticed at different distances from the face. Actually, due to the accommodation of the eye, you can clearly see objects that are a few steps away, as well as at a long distance. Paralysis of accommodation leads to the pathology of this adaptive mechanism. The disease appears if the relationship between the nerve, muscle and lens stops, and there is a violation of the transmission of the nerve impulse to the center of the brain.
Reasons
It is generally accepted that the disease is provoked by psycho-emotional overstrain. Experts are investigating the link between the appearance of symptoms and metabolic disorders in diabetes. Short-term paralytic effects can be traced after acute alcohol intoxication. In patients with chronic alcoholism, twothe eyes are affected symmetrically. A list of the main causes of accommodation paralysis in adults and children includes:
- Infectious diseases. The immobility of accommodation often becomes one of the manifestations of botulism, excited by the toxic effect of botulinum toxin. Bilateral destruction is also found in patients with diphtheria, syphilis and influenza.
- The use of cycloplegics. Transient symptoms occur when M-anticholinergics (atropine) are instilled into the conjunctival sinus. The frequent use of substances in this category can be a source of inconvertible pupil dilation.
- Traumatic defects. The occurrence of signs is combined with a direct or indirect traumatic defect of the ciliary muscle in traumatic brain injury. The disorder is often traced to eye contusion.
- Diseases of the brain. Persistent visual dysfunction probably indicates the development of brain formations (fibroids, atheromatosis, abscesses). Symptoms of transient paralysis are inherent in meningitis or meningoencephalitis.
- Iatrogenic invasion. It appears by the presence of a defect in the ciliary nerves in the process of laser coagulation of the retina. The trigger factor is laser or electrical stimulation of the ciliary muscle. In exceptional cases, immobility is a complication of local barotherapy.
With age, various body functions decrease. They also touch the eyeball. It thickens and disappearsflexibility of the lens, which further leads to a breakdown of accommodation. The destruction of the integument of the brain and the base of the skull, among other things, has a great influence on the formation of the disease.
Risk factors
There are also risk conditions for the formation of cycloplegia:
- diabetes mellitus;
- general reduced adaptability;
- various eye injuries;
- impaired functioning of the brain or ciliary area in traumatic brain injury;
- alcoholism;
- multiple cardiosclerosis;
- Parkinson's disease.
In pharmacology, there are active substances that cause accommodation paralysis. This list included: atropine, amphetamine, elivel, antazoline, belladonna, betamethasone, vincristine, dexamethasone, diphenhydramine, diphenylpyralin, dicyclomine, capoten, finlepsin, rivtagil, naproxen, oxazepam, pentazocine, scopolamine, temazepam, trichlormethiazide, cimetidine, etc.
Symptoms
Violation progresses acutely or subacutely. Patients often associate the appearance of symptoms of accommodation paralysis with stress, infectious diseases, or the use of eye drops.
There are complaints about the change in near vision, less often they complain about far vision. The factor of visiting an ophthalmologist is the inability to carry out ordinary visual work at a sufficiently close distance, to focus on one object.
Patients clearly indicate the time of formation of the first signs of accommodation paralysis and spasm. More often visiondecreases symmetrically, but episodes of unilateral lesions are also described. The disease is predisposed to a relapsing course. If brain damage becomes a factor, the overall clinical picture is dominated by meningeal symptoms, manifested by nausea, uncontrollable vomiting, and intense headache.
Development in children
In adolescents, stable accommodation paralysis is formed between the ages of 7 and 15 years. It is often provoked by:
- stressful environment;
- an acute ailment of a cumulative nature;
- diagnostic instillation of atropine.
Often, these are patients diagnosed with multifunctional CNS disorders.
Key Features
Patients usually complain about certain manifestations of the disease. These include:
- inability to perceive text;
- pupil dilation (visually perceptible);
- inability to make out the inscription (when tilting the head);
- automatically squint eyes when looking at distant objects;
- permanent redness of the eyes, squinting;
- deterioration of distant vision (in some cases);
- desire to rub your eye.
Diseases that provoke pathology
In medical practice, vision pathologies, focus disorders, accommodation pathologies are considered the initial signs of the following lesions:
- Botulism type B. Difficult toxic-infectious disorder associated with CNS damage.
- Adi Syndrome. A neurological disorder characterized by a uniformly dilated pupil. In 50% of patients who have Adie's syndrome, astigmatism occurs due to paresis of the ciliary muscle zones.
What is this disease?
This disease is a disorder in which, due to pathologies of refraction, it is impossible to temporarily change the visual setting of the eyeball. Medical manifestations include a decrease in visual acuity near, high visual asthenicity, difficulty concentrating the gaze when looking at nearby objects.
Diagnosis is based on computer refractometry, visometry, analysis of the accommodative capacity of the eye. Cholinomimetics or α-adrenergic antagonists can be used in the treatment. If the pupillary sphincter or ciliary muscle is injured, surgical therapy is indicated.
Pathogenesis
Accommodation paralysis is formed due to direct or indirect damage to the ciliary muscle and the sphincter of the pupil. These two textures are innervated by specific nerve fibers from the ciliary region.
This explains the fact that a binocular disturbance will be fixed with an externally intact eyeball. With a monocular view, accommodative dysfunction is traced, also referred to as "accommodation inequality". The factor of its appearance is a direct lesion of the ciliary muscle or pupillary sphincter.
Diagnosis
The diagnosis is based onon the information of the anamnesis, impartial examination and the results of instrumental methods. One- or two-sided increase in pupils is visually detected. With mechanical action on the ciliary muscle, sources of subconjunctival hemorrhage are noticeable.
Other modifications from the edge of the anterior sector of the ophthalmic apple are not detected in any way. Typical diagnostic methods are:
- Computer refractometry. The emmetropic or hypermetropic type of medical refraction is predetermined. With hypermetropia, a mismatch of various kinds of axes is recorded.
- Visometry. When carrying out the correction, the acuity of distant vision becomes greater, extremely rarely - it decreases. Near confirmed reduction up to 0.1 diopters. and so on. With the additional use of convex glasses, vision improves.
- Definition of accommodation. Typical sets of negative and positive lenses are used. It turned out to be unrealistic to study the size of the accommodative possibility of an ophthalmic apple, since the closest point of clear vision is connected to the next one.
- Differential check is carried out with suppression of accommodation and presbyopia. With a weakness of accommodation, patients will not be able to clearly note the short-term boundaries of the onset of the first signs; a sharp manifestation is characteristic of paralysis. With presbyopia, the medical manifestations develop in adulthood. Their explicitness builds up over time, which is unusual for paralysis.
Treatment
Taking into account the prerequisites for this pathology of vision, the treatment of accommodation paralysis can go far beyond the boundaries of conventional ophthalmology.
Doctors usually talk about the insufficiency of one or another therapy in cases of drug-induced paralysis. If you eliminate the absence of a certain substance, then near vision will resume on its own.
If after removing the spasm of accommodation in adults (which is diagnosed and managed by doctors of the proper profile), immobility remains, in this case, ophthalmologists prescribe lenses (with plus diopters) in order to correct farsightedness.
Surgical treatment - laser vision correction (by changing the curvature of the cornea with a laser), is indicated for the pathology of refraction of the eye: myopia, hypermetropia, aberration and presbyopia (age-related farsightedness). Accommodation paralysis is not listed in any way.
