ACCOMODATION

ROLL NO. 106,107,108

 parallel rays of light coming from infinity
are brought to focus on the retina, with
accommodation being at rest.
 However, our eyes have been provided
with a unique mechanism by which we
can even focus the diverging rays
coming from a near object on the retina
in a bid to see clearly. This mechanism is
called accommodation.
 Accommodation is a part of near reflex,
also known as near response.
 The near reflex is stimulated by the
blurred retinal image formed by the
divergent rays of light entering the eye
from a near object
Components of Near Reflex
 Accommodation, i.e., increase in
curvature of anterior surface of the
crystalline lens, leading to increase in
focussing power of the lens.
 Constriction of pupil, leading to sharp
focus. It occurs due to reflex contraction
of sphincter pupillae muscle.
 Convergence of eyeball leading to the
focussing of both eyes on the near
object. It occurs due to contraction of the
medial rectus.
Mechanism of
Accomodation
 According to von Helmholtz's capsular theory
the process of accommodation is achieved by
a change in the shape of lens
 When the eye is at rest (unaccommodated),
the ciliary ring is large and keeps the zonules
tense. Because of zonular tension the lens is
kept compressed (flat) by the capsule.
 Contraction of the ciliary muscle causes the
ciliary ring to shorten and thus releases
zonular tension on the lens capsule. The lens
then alters its shape to become more convex
 The nearest point at which small objects can
be seen clearly is called near point or
punctum proximum and the distant
(farthest) point is called far point or
punctum remotum.
 In an emmetropic eye far point is infinity and
near point varies with age.
 In hypermetropic eye far point is virtual and
lies behind the eye
 In myopic eye, it is real and lies in front of the
eye
 Range of accommodation- The
distance between the near point and the
far point.
 Amplitude of accommodation(A)-
The difference between the dioptric
power needed to focus at near point (P)
and far point(R). Thus A = P-R.
Anomalies of accommodation

• Presbyopia
• Insufficiency of Accomodation
• Paralysis of Accomodation
• Spasm of Accomodation
Presbyopia

 Presbyopia (eye sight of old age) is not an error

of refraction but a condition of physiological
insufficiency of accommodation leading to a
progressive fall in near vision.
 After the age of 40 years, near point of
accommodation recedes beyond the normal
reading or working range. This condition of
failing near vision due to age-related decrease
in the amplitude of accommodation or increase
in punctum proximum is called presbyopia.
CAUSES
1. Age-related changes in the lens which
include decrease in the elasticity of lens
capsule and progressive increase in size and
hardness (sclerosis) of lens substance
2. Age-related decline in ciliary muscle power
may also contribute in causation of
presbyopia.
Causes of premature presbyopia are:
* Uncorrected hypermetropia.
* Premature sclerosis of the crystalline lens.
* Chronic simple glaucoma.
SYMPTOMS
1.Difficulty in near vision
2. Asthenopic symptoms due to fatigue of the
ciliary muscle are also complained after
reading or doing any near work.
TREATMENT
1.Optical treatment- The treatment of
presbyopia is the prescription of appropriate
convex glasses for near work.
2.Surgical treatment
Insufficiency of
Accomodation
It occurs when the accommodative power is significantly
less
than the normal physiological limits for the patient's age.
Can
be labelled as pathological insufficiency accommodation.
CAUSES
1. Premature sclerosis of lens
2. Weakness of ciliary muscle due to systemic causes
muscle fatigue such as debilitating illness, malnutrition,
diabetes mellitus, stress
3. Weakness of ciliary muscle associated with primary angle
glaucoma
4. Cyclitis, i.e., inflammation of the ciliary body
TREATMENT
 1.Near vision spectacles in the form of

weakest convex lens which allows

adequate vision should be given till the
power of accommodation improves
 2. Accommodation exercises help in

recovery, if the underlying debility has

passed.
 Paralysis of Accomodation
Paralysis of accommodation also known as
cycloplegia refers to complete absence of
accommodation.
CAUSES
1. Drug induced cycloplegia due to the effect of
atropine, homatropine or other parasympatholytic
drugs
2. Neuritis associated with diphtheria, syphilis,
diabetes, alcoholism, cerebral or meningeal
diseases. The condition is usually bilateral
3. Intracranial or orbital causes. The lesions may be
traumatic, inflammatory or neoplastic in nature
CLINICAL FEATURES
1. Blurring of near vision
2. Photophobia (glare) due to accompanying
dilatation of pupil (mydriasis)
3. Abnormal receding of near point and markedly
decreased range of accommodation
TREATMENT
1. Self-recovery occurs in drug-induced cycloplegia
2. Dark glasses are effective in reducing the glare.
3. Convex lenses for near vision may be prescribed
if the paralysis is permanent.
Spasm of Accomodation
 It refers to exertion of abnormally excessive
accommodation. The condition, also called as
cyclotonia, is more common in young adults,
especially myopes.
 Causes
 1. Drug-induced spasm of accommodation after
use of strong miotics such as echothiophate
 2. Spontaneous spasm of accommodation is
occasionally found in children who attempt to
compensate for a refractive anomaly that
impairs their vision.
CLINICAL FEATURES
1. Sudden defective vision due to induced
myopia (pseudomyopia)
2. Asthenopic symptoms are more marked than
the visual symptoms.
TREATMENT
1. Relaxation of ciliary muscle by atropine for
few weeks
2. Correction of associated causative factors
prevent recurrence
3. Assurance and if necessary psychotherapy