Accommodative Spasms: A Literature Review on Prevalence, Etiology and Treatment

Abstract

Relevance: Accommodative spasm is an underdiagnosed cause of pseudomyopia in children and adolescents, associated with intensive near-work demands. Diagnostic and therapeutic heterogeneity complicates its clinical management, highlighting the need for an updated synthesis of the available evidence.

Abstract: Accommodative spasm is an uncommon disorder characterized by an involuntary, sustained contraction of the ciliary muscle that produces pseudomyopia and fluctuating visual symptoms. A structured literature review was conducted using Pubmed and Embase following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, including original studies and case reports published between 1976 and 2024 related to prevalence, etiology, and treatment. Forty-six articles were included, of which 22 corresponded to original studies and 24 to case reports. Reported prevalence ranged from 0.3% to 5.4%, with a higher frequency in school-age populations subjected to high near-vision demands. The identified causes were mainly functional, psychogenic, and organic, frequently presenting with a multifactorial pattern. The most used treatments combined pharmacologic cycloplegia, plus lenses, and vision therapy, showing clinical improvement in most of the reported cases. Cycloplegic refraction remains essential to differentiate pseudomyopia from true myopia. A multidisciplinary approach, together with visual hygiene measures and individualized clinical follow-up, appears to improve functional outcomes and reduce recurrence. The limited methodological quality and heterogeneity of the included studies highlight the need for prospective research with standardized diagnostic criteria and longer follow-up.