Accommodation - 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., to accurately establish observable objects that are at different distances from the person. Actually, due to accommodation of the eye, you can clearly see objects that are at a few steps, as well as at a long distance. Paralysis of accommodation leads to the pathology of this adaptive mechanism. A disease appears if the relationship between the nerve, muscle and lens is stopped, while there is a violation of the transmission of a nervous impulse to the center of the brain.
Causes
It is generally accepted that the disease is provoked by psycho-emotional overstrain. Experts examine the relationship between the onset of symptoms and metabolic disorders in diabetes. Short-term paralytic effects are traced after acute alcohol intoxication. In patients with chronic alcoholism, two eyes are affected symmetrically. The list of main causes of accommodation paralysis in adults and children includes:
- Infectious diseases. The immobility of accommodation often becomes one of the manifestations of botulism, is excited by the toxic effect of botulinum toxin. Bilateral destruction, in addition, is found in patients with diphtheria, syphilis and influenza.
- The use of cycloplegics. Transient symptoms occur upon instillation in the conjunctival sinus of M-anticholinergics (atropine). The frequent use of substances of this category can be a source of non-convertible pupil expansion.
- Traumatic defects. The onset of symptoms is combined with a direct or indirect traumatic defect of the ciliary muscle in traumatic brain injury. Violation is often seen due to eye contusion.
- Diseases of the brain. Stable visual dysfunctionality probably indicates the development of brain formations (fibroids, atheromatosis, abscess). Symptoms of transient paralysis are inherent in meningitis or meningoencephalitis.
- Iatrogenic invasion. It appears by the presence of a defect in the ciliary nerves during laser retinal coagulation. The trigger factor is laser or electrical stimulation of the ciliary muscle. In exceptional embodiments, immobility is a complication of local barotherapy.
With age, a decrease in all kinds of body functions occurs. They also touch the eyeball. In it, the crystalline lens is compacted and lost, which still leads to a breakdown in 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
The risk conditions for the formation of cycloplegia are also noted:
- diabetes;
- general reduced adaptability;
- all kinds of eye injuries;
- impaired functioning of the brain or ciliary area with traumatic brain injury;
- alcoholism;
- multiple cardiosclerosis;
- Parkinson's disease.
In pharmacology, there are active substances that cause accommodation paralysis. On this list were: atropine, amphetamine, elivel, antazolin, belladonna, betamethasone, vincristine, dexamethasone, diphenhydramine, diphenylpyraline, dicyclomine, capoten, finlepsin, rivtagil, naproxen, oxazepam, pentazocine, scopolamine, drazimetis, drimitaz, temprizimet, tempazimetis, dromezimet, tempazimetis, tempazimetis, tempazimetis.
Symptoms
Violation progresses acutely or subacute. Patients often combine the onset of symptoms of accommodation paralysis with stress, infectious diseases, or the use of eye drops.
There are complaints of a manifested change in near vision, less often complain of distant vision. The factor of contacting an ophthalmologist is the inability to carry out normal visual work at a fairly close distance, to focus on one object.
Patients clearly indicate the time of formation of the first signs of accommodation paralysis and spasm. Most often, vision decreases symmetrically, but episodes of a one-sided lesion are also described. The disease is prone to recurrent course. If brain damage becomes a factor, meningeal symptoms prevail in the general clinical picture, manifested by nausea, indomitable vomiting, and intense headache.
Development in children
In adolescents, stable accommodation paralysis forms between the ages of 7 and 15. Often it is provoked:
- stressful environment;
- acute illness of an aggregate nature;
- diagnostic instillation of atropine.
Often, these are patients with diagnosed multifunctional disorders of the central nervous system.
Key features
Patients usually complain of certain manifestations of the disease. These include:
- inability to perceive the text;
- pupil dilation (visually noticeable);
- the inability to make out the inscription (when tilting the head);
- automatic squinting eyes when viewing objects far;
- constant redness of the eyes, squinting;
- deterioration in distant vision (in some cases);
- desire to rub the eye.
Pathological diseases
In medical practice, vision pathologies, focusing disorders, accommodation pathologies are considered the initial signs in the following lesions:
- Botulism of type B. Difficult toxic-infectious disorder, associated with damage to the central nervous system.
- Adi's Syndrome. Neurological disorder, distinctive uniformly dilated pupil. In 50% of patients in whom Adi syndrome is found, astigmatism occurs, which is formed due to paresis of the zones of the ciliary muscle.
What is this disease?
This disease is a violation in which, due to refraction pathologies, it is impossible to change the visual setting of the eyeball for a while. Medical manifestations include a decrease in visual acuity near, high visual asthenicity, difficulty concentrating eyes when examining nearby objects.
Diagnosis is based on computer refractometry, visometry, and analysis of the accommodative ability of the eye. In treatment, cholinomimetics or antagonists of a-adrenergic receptors can be used. In case of injury to the pupil sphincter, or ciliary muscle, surgical therapy is indicated.
Pathogenesis
Accommodation paralysis is formed due to direct or indirect damage to the ciliary muscle and pupil sphincter. These two textures are innervated by special nerve fibers from the ciliary region.
This explains the fact that the binocular disorder is fixed with an apparently intact eyeball. In a monocular form, accommodation non-functional accommodations can be traced, also called “accommodation inequality”. The factor of its appearance is a direct lesion of the ciliary muscle or pupillary sphincter.
Diagnostics
Diagnosis is based on medical history, impartial examination, and instrumental findings. One or two-sided enlargement of the 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. Typical diagnostic methods are:
- Computer refractometry. The emmetropic or hypermetropic type of medical refraction is determined. With hyperopia, a mismatch of various kinds of axes is recorded.
- Visometry During the correction, the visual acuity becomes greater, extremely rarely - decreases. Close confirmed by a reduction of up to 0.1 diopters. and further. With the additional use of convex glasses, vision improves.
- Definition of accommodation. Typical sets of negative and positive lenses are used. To investigate the size of the accommodation capacity of an ophthalmic apple turned out to be unrealistic, since the closest point of clear vision is connected with the next.
- Differential verification is carried out with depression of accommodation and presbyopia. With weak accommodation, patients will not be able to clearly notice the short-term boundaries of the first signs, paralysis is characterized by a sharp manifestation. With presbyopia, medical manifestations develop in adulthood. Their explicitness increases 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 failure of a particular therapy in cases of drug paralysis. If you eliminate the absence of a certain substance, then near vision resume on its own.
If immobility remains after removing the accommodation spasm in adults (which is diagnosed and conducted by doctors of the proper profile), then ophthalmologists write out lenses (with positive diopters) in order to correct hyperopia.
Surgical treatment - laser vision correction (by changing the curvature of the cornea with a laser), is indicated for pathology of eye refraction: myopia, hyperopia, aberration and presbyopia (age-related hyperopia). Paralysis of accommodation in the list of indications is not listed in any way.