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 |   Related post: By GEORGE F. SUKER, M. D., TOLEDO, OHIO. The spasm of accommodation is frequently, if not gen- erally, brought about by the abuse and excessive use of the muscles of accommodation under unfavorable circumstances- The causes of spasm may be enumerated as follows: 1. One of the most frequent causes is working with minute objects, which can only be seen distinctly when brought closer to the eye than the normal punctuin. proxi- mum. Especially is this so when the work is carried on by scant illumination for anv length of time^e. i/., reading fine print during twilight hours, writing, or doing line needlework. For the same reason, in order to obtain a larger retinal image, amblyopes and astigmatics hold their objects so near their eyes as easily to subject themselves to spasm of the accommodation. Hyperopic refraction at all times calls forth an excessive employment of accom- modation when no glasses are worn or when the glass worn is too weak. It is for this reason that we so often find all kinds of spasm of accommodation among the hyperopes. This is especially prominent among students, the majority of whom are hyperopic. These often wear no correcting glasses, thus leaving a good share of the range of accommodation latent, which invariably produces a spasm. 2. Irritation of the ciliary muscles, especially of the ciliary nerves, often gives rise Buy Phenazopyridine to various forms of spasm. The progressive form of myopia may be mentioned in this connection as producing spasm, also incipient glaucoma. 3. Insufficiency of the recti interni is another cause of spasm. At the same time insufficient externi recti are prone to produce more or less spasm of accommodation; for with insufficient interni recti an effort far above the normal is called for to achieve the necessary convergence to maintain the point of fixation, and this calls forth too great a strain on the power of accommodation. This is so from the fact that convergence and accommodation, up to a certain point, are closely related actions. This state of alfairs is prominently brought forth in myopes. 4. Furtlieimore, various kinds of traumatisms are very apt to produce spasm of the accommodation. Foreign bodies in the conjunctiva or in the cornea frequently main- tain a spastic myosis or accommodation for the near point. The spasm here is due to reflex irritation. 5. Morphine and calabar bean are cited as specific causes of certain forms of spasm. Even a spasm of the orbicularis palfiebrarum has been credited by von Graefe with having caused spasm of the accommodation. How spasm of this muscle could produce a similar condition of the muscle of Purchase Phenazopyridine Online accommodation is rather strange indeed. 6. The effort to overcome diplopia, especially in recent cases, may yive rise to spasm of accommodation. This oc- curs more frequently when the diplojna is due to insuffi- cient muscles than w hen it is due to other ocular defects. 178 LEADING ARTICLES. [N. Y. Med. JonB., 7. At times, on the instillation of homatropine, a spasm of accommodation may arise. This usually occurs when five or six applications have been made, and may be ac- counted as a reflex spasm. This form is of short duration, and can be overcome easily by the continuance of the homatropine or by the use of the ordinary sulphate Purchase Phenazopyridine of atro- pine, preferably the latter. 8. Certain hyperaestbctic conditions of the retina may bring about spasm of accommodation. This is purely of a reflex nature. It occurs in cases where the retina is over-sensitive to diffusion circles. The retina is tbe reo-u- lator, as it were, of the accurate image foi mation, and the inaccuracy dependent on the diffusion circles is the point of irritation giving rise to a reflex spasm. 9. Finallv, inflammatory conditions of the conjunctiva, cornea, or sclera are capable at times of producing spasm. This is found mostly among those of a highly strung nerv- ous svstem, in whom the slightest irritation is sufficient to produce a spasm of almost any muscle. The rarer forms of spasm are attributed to epilepsy, hysteria, and disturb- ances of the central nervous system. Irritation of the cilio spinal center may produce the same condition spoken of. Then, too, certain brain lesions are credited with the production of spasm of the muscle of accommodation. The treatment of spasm of accommodation is as fol- lows: 1. If possible, remove the exciting cause; this certainly is of prime importance. 2. Avoid the continual straining of the eyes ; advise frequent intervals of rest if work can not be entirely suspended. 3. Obtain the best illumination possible ; ameliorate the too intense light by wearing smoked lenses. 4. Treat any insufficient muscle ; relieve all irritations. 5. The spasm which produces a certain amount of latent hyperopia is to be overcome by prescribing suitably adjusted convex glasses. The same may be said of myopia and astigmatism. It is not abso- lutely necessary to correct the entire amount of hyperopia, for Order Phenazopyridine a certain portion may remain uncorrected without caus- ing any evil results. 6. In myopes, when the spasm is due to irritation of the ciliary muscle, it can be overcome by local leeching and insistence upon absolute rest for the eyes. 1. The mainstay in the treatment is the sulphate of atropine, which is sure to allay the spasm as long as it is instilled, and in the majority of Order Phenazopyridine Online cases gives a cure, pro- viding the former exciting causes are to a great extent done away with. A stronger solution than usual is em- ployed, for it takes a longer time for it to act on a spastic muscle than on a normal one. One may employ it as strong as gr. j to 3 j or 3 ij of water, two or three drops to be instilled three or four limes daily. 8. In traumatic cases make use of antiphlogistic measures. Remove for- eign bodies if there are any present. 9. The constant gal- vanic current is much lauded in certain cases. At times a rapid local abstraction of blood may materially reduce the spasm for the time being. At no time should we forget to make use of constitutional treatment. If atropine produces untoward effects, sulphate of duboisine may be used in its stead, though it is not so reliable as the former. Upon the whole, the Buy Phenazopyridine Online treatment of spasm of accommoda- tion is satisfactory both to the patient and to the physician. NEW YORK MEDICAL JOURNAL, A Weekly Review of Medicine. Piibliehed by D. Appleton & Co. Edited by Frank P. Postbb, M. D. 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