Functional Spasm of Accommodation.

FUNCTIONAL spasm of accommodation was described by von Graefe (1856), and there are many case reports in the literature (Duke-Elder, 1949). The condition is sufficiently infrequent to retain a slightly bizarre flavour. The cases which occur sporadically in the out-patient departments of hospitals tend to be dismissed as relatively unimportant, and it is rare to be able to obtain an effective follow-up in hospital work. For this reason the material for this paper has been obtained from the records of a series of 12 private patients. One has been followed for 29 years, one for 14 years, one for 10 years, two for 5 years, one for 4 years, two for 3 years, two for 2 years, and two for 1 year or less. Naturally, the condition is restricted to age groups in which the accommodation is active. In my series three patients were under 10 years of age, four between 10 and 20 years, two between 20 and 30 years, and the others 30, 32, and 33 years respectively at the time of their attacks. In one patient who has been followed from the age of 30 to 60, while the pseudo-myopia has disappeared with advancing age, symptoms strongly suggesting spasm of the ciliary muscles still recur. For the purpose of this paper it has been possible to make a careful study of 21 attacks of accommodative spasm, as recurrences of the trouble have been frequent. Six patients have had one attack, three have had two attacks, and three have had three or more attacks. There were eight females as against four males, though the more serious symptoms all occurred in males.