Persistent accommodative spasm after severe head trauma
- M L R Monteiro1,
- A L L Curi2,
- A Pereira3,
- W Chamon4,
- C C Leite5
- 1Department of Ophthalmology, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil
- 2Department of Ophthalmology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
- 3Department of Ophthalmology, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil
- 4Department of Ophthalmology, São Paulo Federal University, São Paulo, Brazil
- 5Department of Radiology, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil
- Correspondence to: Mário L R Monteiro, MD, Av Angélica 1757 conj.61, 01227–200, São Paulo, SP, Brazil; mlrmonteiro{at}terra.com.br
- Accepted 18 July 2002
Spasm of accommodation is the sudden development of a considerable degree of myopia which disappears after cycloplegia, usually functional in origin.1 Bohlmann and France2 reported a patient with persistent spasm of accommodation 9 years after head trauma and suggested that a possible lesion in the upper brainstem might be responsible for the dysfunction. We report two similar cases in which magnetic resonance imaging (MRI) failed to show abnormalities in the mid-brain and revealed cerebellar and supratentorial traumatic lesions.
Case reports
Case 1
A 34 year old female patient came to the refractive surgery service for correction of myopia and astigmatism. She had been comatose for 45 days after suffering severe head injury at the age of 24, and 3 months later noticed difficulties in her distant vision and was prescribed corrective lenses.
Dynamic refraction revealed in the right eye −3.75 sph −1.50 cyl × 5 and in the left eye −3.50 sph −1.00 cyl × 170. Visual acuity was 20/25 in each eye with this correction. Pupils were equal in size and measured 5 mm in normal room light, with normal reactions. Cycloplegic refraction after instillation of two drops of 1% cyclopentolate and one drop of 1% tropicamide revealed −1.25 sph −1.50 cyl × 5 right eye …
