Abstract
Pseudomyopia is an inappropriately excessive accommodation of the eye due to overstimulation or ciliary spasm, which leads to a marked approximation of the far point. Common symptoms of pseudomyopia include eye strain or fatigue, and it is classified as organic or functional. The latter is due to eye strain and functional increase in the ciliary tonus. Pseudomyopia can vary from being a transient condition or continue to progress to myopia. Head trauma is the most common cause followed by psychiatric illnesses, neurologic diseases, and drug-induced causes. There is an association between psychological stress-inducing events and pseudomyopia as it affects the autonomic nervous system. The human body counteracts anxiety by activating the parasympathetic nervous system, causing ciliary muscle contraction. Underlying psychiatric diseases in pseudomyopia patients have been reported in the past in multiple studies. Generalized anxiety disorder is the most common psychiatric illness associated with pseudomyopia with a positive correlation between anxiety-somatization scores and accommodation amount of the eye. It is strongly advised that a psychiatric consultation should be included in the multidisciplinary evaluation of every case. If patients have coexisting anxiety disorders, a multidisciplinary approach using psychiatric consultations, work environment changes, ocular exercises, and cycloplegic drugs can be used. This review aims to shed light on the association of psychiatric disorders such as anxiety with pseudomyopia.
Highlights
BackgroundPseudomyopia or accommodative spasm occurs because of excessive constriction of the ciliary muscle which clinically manifests as blurred vision, distorted image, photophobia, and ocular pain
There are various hypotheses to explain the correlation, there are fewer studies that acknowledge the involvement of the neuronal pathways or the specific brain regions which explain the occurrence of pseudomyopia in anxiety and vice-versa
Diagnostic and treatment procedures of pseudomyopia associated with anxiety When evaluating patients with myopia, especially those who have myopia associated with diplopia or strabismus, pseudomyopia or accommodative spasm must always be kept in mind as an alternative diagnosis [31]
Summary
Pseudomyopia or accommodative spasm occurs because of excessive constriction of the ciliary muscle which clinically manifests as blurred vision, distorted image, photophobia, and ocular pain. It is clear that psychological causes affect the autonomic nervous system This case reinforces that the visual symptoms might not be associated with any abnormal brain imaging as the MRI for this patient was normal. In patients who have pseudomyopia with coexisting anxiety disorders, a multidisciplinary approach has been used to manage and treat pseudomyopia which includes using psychiatric consultations and work environment changes, ocular exercises, and using cycloplegics to relax the ciliary muscle spasm. Hyndman summarized how over the years, the use of psychiatric medications in carefully selected cases has led to the resolution of pseudomyopia He described the resolution of accommodative spasms with the use of sertraline, diazepam, valproate, promethazine, bromocriptine, and Amytal in different scenarios where pseudomyopia was associated with psychiatric disorders like anxiety [6]. Radical treatments that permanently paralyze a patient’s ability to accommodate for life include clear lens exchanges which are reserved for rare treatmentunresponsive cases [38]
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