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

• Antidepressants
• Extreme fatigue
• Diabetes mellitus
• Head trauma

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

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