Accommodative insufficiency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Accommodative insufficiency (AI) involves the inability of the eye to focus properly on an object. Approximately 80 percent of children diagnosed with CI (convergence insufficiency) also demonstrate AI.

Causes

Common Causes

Causes by Organ System

Cardiovascular	Anemia, arteriosclerosis, diabetes mellitus, Down syndrome, myotonic dystrophy, thyroid disease
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Decompression sickness, measles
Drug Side Effect	Antidepressants, antihistamines, ritalin, sulphasalazine
Ear Nose Throat	Down syndrome, Fragile X syndrome, measles
Endocrine	Diabetes mellitus, myotonic dystrophy, thyroid disease
Environmental	No underlying causes
Gastroenterologic	Chronic alcoholism, decompression sickness, diabetes mellitus, Down syndrome, measles, multiple sclerosis, myasthenia gravis, myotonic dystrophy, thyroid disease
Genetic	Down syndrome, Fragile X syndrome, myotonic dystrophy
Hematologic	Anemia
Iatrogenic	No underlying causes
Infectious Disease	Influenza, whooping cough
Musculoskeletal/Orthopedic	Decompression sickness, diabetes mellitus, Down syndrome, Fragile X syndrome, multiple sclerosis, myasthenia gravis, myotonic dystrophy
Neurologic	Cerebral palsy, chronic alcoholism, decompression sickness, diabetes mellitus, Down syndrome, extreme fatigue, Fragile X syndrome, head trauma, left middle cerebral artery occlusion, measles, mild traumatic brain injury, multiple sclerosis, myasthenia gravis
Nutritional/Metabolic	Chronic alcoholism, diabetes mellitus, malnutrition
Obstetric/Gynecologic	Fragile X syndrome
Oncologic	No underlying causes
Ophthalmologic	Amblyopia, arteriosclerosis, astigmatism, cerebral palsy, convergence insufficiency, cycloplegia, decompression sickness, diabetes mellitus, Down syndrome, eye strain, Fragile X syndrome, hyperopia, inability of the ciliary body to contract, influenza, measles, mild traumatic brain injury, multiple sclerosis, myasthenia gravis, myopia, myotonic dystrophy, ocular inflammation, presbyopia, pseudomyopia, sclerosis of the crystalline lens, senile cataract, spasm of accommodation, thyroid disease, uveitis
Overdose/Toxicity	No underlying causes
Psychiatric	Down syndrome, multiple sclerosis
Pulmonary	Decompression sickness, influenza, measles, myasthenia gravis, whooping cough
Renal/Electrolyte	Diabetes mellitus, Down syndrome
Rheumatology/Immunology/Allergy	Myasthenia gravis
Sexual	Fragile X syndrome, multiple sclerosis
Trauma	Head trauma, mild traumatic brain injury, whiplash injuries
Urologic	Multiple sclerosis
Miscellaneous	Aging, altitude, extreme fatigue, eye strain, high stress, idiopathic, multiple sclerosis, video display terminals (VDT) users

Causes in Alphabetical Order

^[1]^[2]^[3]^[4]^[5]

Aging
Altitude
Amblyopia
Anemia
Antidepressants
Antihistamines
Arteriosclerosis
Astigmatism
Cerebral palsy^[6]
Chronic alcoholism
Convergence insufficiency
Cycloplegia
Decompression sickness^[7]
Diabetes mellitus
Down syndrome^[6]
Extreme fatigue
Eye strain
Fragile X syndrome^[8]
Head trauma
High stress
Hyperopia
Idiopathic
Inability of the ciliary body to contract
Influenza
Left middle cerebral artery occlusion^[9]
Malnutrition
Measles
Mild traumatic brain injury^[10]
Multiple sclerosis
Myasthenia gravis^[11]
Myopia
Myotonic dystrophy
Ocular inflammation
Presbyopia^[6]
Pseudomyopia
Ritalin
Sclerosis of the crystalline lens
Senile cataract
Spasm of accommodation^[12]
Sulphasalazine^[13]
Thyroid disease
Uveitis
Video display terminals (VDT) users^[14]
Whiplash injuries
Whooping cough

References

↑ Duke-Elder S. System of Ophthalmology, vol V Ophthalmic Optics and Refraction. St Louis, Mosby, 1970 451- 486.
↑ Cooper J. Accommodative dysfunction. In: Amos JF. Diagnosis and management in Vision Care. Boston: Butterworths, 1987 431-54.
↑ Daune A. Anomalies of Accommodation clinically considered. Trans Am Ophthalmol Soc. 1913 1 386- 400.
↑ Scheiman M, Wick B. Clinical management of binocular vision: Heterophoric, Accommodative, and Eye movement disorders. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2002: 334-369.
↑ Daum KM. Accommodative insuffi ciency. Am J Optom Physiol Opt 1983a 60 352-359.
↑ ^6.0 ^6.1 ^6.2 Roche O, Roumes C, Parsa C (2007). "[Techniques for measuring phakic and pseudophakic accommodation. Methodology for distinguishing between neurological and mechanical accommodative insufficiency]". J Fr Ophtalmol. 30 (9): 953–60. PMID 18046282.
↑ Lieppman ME (1981). "Accommodative and convergence insufficiency after decompression sickness". Arch Ophthalmol. 99 (3): 453–6. PMID 7213164.
↑ Amin VR, Maino DM (1995). "The fragile X female: a case report of the visual, visual perceptual, and ocular health findings". J Am Optom Assoc. 66 (5): 290–5. PMID 7629369.
↑ Ohtsuka K, Maekawa H, Takeda M, Uede N, Chiba S (1988). "Accommodation and convergence insufficiency with left middle cerebral artery occlusion". Am J Ophthalmol. 106 (1): 60–4. PMID 3394770.
↑ http://www.rehab.research.va.gov/jour/10/473/Green.html
↑ Matsui M, Enoki M, Matsui Y, Oono S, Ohta M, Suenaga A; et al. (1995). "Seronegative myasthenia gravis associated with atonic urinary bladder and accommodative insufficiency". J Neurol Sci. 133 (1–2): 197–9. PMID 8583227.
↑ Daum KM (1983). "Accommodative dysfunction". Doc Ophthalmol. 55 (3): 177–98. PMID 6884172.
↑ Magnus JH, Elverland HH, Olsen EG, Husby G (1993). "Facial palsy and partial accommodative insufficiency associated with sulphasalazine treatment in a patient with ankylosing spondylitis". Scand J Rheumatol. 22 (4): 199–201. PMID 8102809.
↑ Scheiman M (1996). "Accommodative and binocular vision disorders associated with video display terminals: diagnosis and management issues". J Am Optom Assoc. 67 (9): 531–9. PMID 8888886.

Template:WH Template:WS

[1] Duke-Elder S. System of Ophthalmology, vol V Ophthalmic Optics and Refraction. St Louis, Mosby, 1970 451- 486.

[2] Cooper J. Accommodative dysfunction. In: Amos JF. Diagnosis and management in Vision Care. Boston: Butterworths, 1987 431-54.

[3] Daune A. Anomalies of Accommodation clinically considered. Trans Am Ophthalmol Soc. 1913 1 386- 400.

[4] Scheiman M, Wick B. Clinical management of binocular vision: Heterophoric, Accommodative, and Eye movement disorders. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2002: 334-369.

[5] Daum KM. Accommodative insuffi ciency. Am J Optom Physiol Opt 1983a 60 352-359.

[pmid18046282-6] 6.0 ^6.1 ^6.2 Roche O, Roumes C, Parsa C (2007). "[Techniques for measuring phakic and pseudophakic accommodation. Methodology for distinguishing between neurological and mechanical accommodative insufficiency]". J Fr Ophtalmol. 30 (9): 953–60. PMID 18046282.

[pmid7213164-7] Lieppman ME (1981). "Accommodative and convergence insufficiency after decompression sickness". Arch Ophthalmol. 99 (3): 453–6. PMID 7213164.

[pmid7629369-8] Amin VR, Maino DM (1995). "The fragile X female: a case report of the visual, visual perceptual, and ocular health findings". J Am Optom Assoc. 66 (5): 290–5. PMID 7629369.

[pmid3394770-9] Ohtsuka K, Maekawa H, Takeda M, Uede N, Chiba S (1988). "Accommodation and convergence insufficiency with left middle cerebral artery occlusion". Am J Ophthalmol. 106 (1): 60–4. PMID 3394770.

[10] ttp://www.rehab.research.va.gov/jour/10/473/Green.html

[pmid8583227-11] Matsui M, Enoki M, Matsui Y, Oono S, Ohta M, Suenaga A; et al. (1995). "Seronegative myasthenia gravis associated with atonic urinary bladder and accommodative insufficiency". J Neurol Sci. 133 (1–2): 197–9. PMID 8583227.

[pmid6884172-12] Daum KM (1983). "Accommodative dysfunction". Doc Ophthalmol. 55 (3): 177–98. PMID 6884172.

[pmid8102809-13] Magnus JH, Elverland HH, Olsen EG, Husby G (1993). "Facial palsy and partial accommodative insufficiency associated with sulphasalazine treatment in a patient with ankylosing spondylitis". Scand J Rheumatol. 22 (4): 199–201. PMID 8102809.

[pmid8888886-14] Scheiman M (1996). "Accommodative and binocular vision disorders associated with video display terminals: diagnosis and management issues". J Am Optom Assoc. 67 (9): 531–9. PMID 8888886.

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