Accommodative spasm and its different treatment approaches: A systematic review

Eur J Ophthalmol. 2023 May;33(3):1273-1286. doi: 10.1177/11206721221136438. Epub 2022 Nov 16.


This article is about the accommodation spasm. The primary rule for near vision is ciliary muscle constriction, synchronised convergence of both eyes, and pupil constriction. Any weaknesses in these components could result in an accommodative spasm. Variable retinoscopic reflex, unstable refractive error, and lead of accommodation in near retinoscopy are common causes of spasm. We conducted a thorough literature search in the PubMed and Google Scholar databases for published journals prior to June 2022, with no data limitations. This review contains twenty-eight case reports, six cohort studies, four book references, four review articles, and two comparative studies after applying the inclusion and exclusion criteria. The majority of studies looked at accommodative spasm, near reflex spasm, and pseudomyopia. The most common causes of accommodative spasm are excessive close work, emotional distress, head injury, and strabismus. Despite side effects or an insufficient regimen, cycloplegic drops are effective in diagnosing accommodation spasm. The modified optical fogging technique is also effective and may be an option for treating accommodative spasm symptoms. Bifocals for near work, manifest refraction, base-in prisms, and vision therapy are some of the other management options. As a result, it requires a comprehensive clinical treatment strategy. This review aims to investigate the various aetiology and treatments responsible for accommodative spasm and proposes widely implementing the modified optical fogging method and vision therapy in clinics as comprehensive management to reduce the future upward trend of accommodative spasm.

Keywords: Refraction; heterophoria; neuro imaging; ocular motility disorder; pharmacology.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Accommodation, Ocular
  • Humans
  • Mydriatics / therapeutic use
  • Myopia* / etiology
  • Refractive Errors*
  • Spasm / diagnosis
  • Spasm / etiology
  • Spasm / therapy
  • Vision, Low* / complications


  • Mydriatics