Spasm of Near Synkinetic Reflex: Outcomes of a Comprehensive Management Protocol

Abstract

Objective: To find out the frequency of spasm of near reflex presenting to our clinic and outline the management outcomes. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022. Methodology: A patient who was suspected to have spasm of near reflex underwent subjective and objective refraction and detailed orthoptic evaluation. Dry and cycloplegic retinoscopy was obtained along with post-mydriatic refraction achieved after 3 days of Cycloplegic. Spasm of near reflex was categorized as mild if it resolves on administration of a weaker cycloplegic drug like cyclopentolate, moderate if administration of stronger cycloplegic i.e., atropine/homatropine is required or severe if long term home therapy of atropine 0.5% once daily is required. Results: Our study included 236 patients with suspected spasm of near reflex, among which it was confirmed in 200 only. Of the 200 patients with confirmed spasm of near reflex, there were 74 mild cases (37%), with no spasm of near reflex during their post-cycloplegic visit. Eighty-eight patients (44%) had moderate spasm of near reflex that was relieved by the post atropine examination. Whereas, 38 patients (19%) had severe spasm of near reflex, requiring long-term atropine 0.5% management. Conclusion: Spasm of near reflex is often a diagnostic dilemma which is otherwise not very difficult to treat. Most of such cases were found to be mild to moderate having good visual outcomes to once or twice application of moderate (Cyclopentolate 1%) to stronger acting Cycloplegic eye drops (Atropine 1%).