Cycloplegia


Cycloplegia

Description, Causes and Risk Factors:

Loss of power in the ciliary muscle of the eye; may be by denervation or by pharmacologic action.

The ciliary muscle is a muscle in the ciliary body, an area of the eye which helps people focus. With the assistance of the ciliary muscle, the lens of the eye can be flattened or rounded to allow people to focus on distant and near objects. This muscle is also responsible for controlling part of the drainage system of the eye to maintain the proper fluid pressure in the eye.

Cycloplegia

This smooth muscle is circular, surrounding the lens of the eye. It is attached to the lens with small fibers known as zonules or suspensory ligaments. When the ciliary muscle is relaxed, the ligaments are pulled taught, which flattens the lens of the eye. With a flattened lens, someone can see more distant objects. When the ciliary muscle is contracted, the ring becomes smaller, and the lens is pushed into a rounded and bulged shape which allows it to focus on near objects. The shape of the lens can be minutely adjusted for fine tuning when it comes to focus.

Cycloplegia may be either partial or complete, and the cause may be either local or general. If but one eye is affected, the cause is more opt to be local, affecting the third nerve in some part of its course, and the primary cause may be syphilis. Some injury of the eye or orbit may cause it, through some reflex influence, as may also some irritation of the fifth nerve, as in decayed teeth, et cetera. When the paralysis affects the ciliary body of both eyes the cause is more opt to be general and often from some constitutional disorder. The most frequent cause is diphtheria and comes on usually during convalescence or some time after. Cycloplegia is also seen after fevers such as typhoid and recurrent fever. If is also occurs in diabetes, articular rheumatism, locomotor ataxia, after debilitating excesses as masturbation, sexual indulgence, etc. It is sometimes found due to uterine disease and from syphilis. It is also present with paralysis of the external muscle in total paralysis of the third nerve.

Prognosis is as a rule, in these cases favorable, for as the majority of cases result from diphtheria, fevers, etc., the proper treatment will effect a relief. It must be borne in mind, however, that the cycloplegia may be the forerunner of some grave general condition which may be of serious import to the life of the patient, as for example when due to diabetes, to some obscure cerebral or spinal disease, etc. Hence the prognosis always depends upon a correct diagnosis as to the cause of the malady.

Symptoms:

Because of the paralysis of the ciliary muscle in the eye, the curvature of the lens can no longer be adjusted to focus on nearby objects. This results in similar problems as those caused by presbyopia, in which the lens has lost elasticity and can also no longer focus on close by objects.Other symptoms include headache, eyestrain, difficulty reading, and blurry vision.

Diagnosis:

The diagnosis of cycloplegia depends upon the one constant symptom, viz., the diminution or complete abolition of the amplitude of accommodation from a recession of the near point. This will always be suspected in subjects who formerly had good vision for near objects, but find they can only seem well at a distance. The pupil will usually, at the same time, be dilated, through frequently there will be a paresis of accommodation without mydriasis.

Treatment:

The cause of the cycloplegia must be sought out and given due consideration in the treatment. As precautionary measures, all convalescents should be carefully warned of the danger of overtaxing the eyes. The use of locally of Eserine™ or Diocarpine® of sufficient strength to slightly contract the pupil and stimulate the accommodation is of great value.

Cycloplegic drugs are generally muscarinic receptor blockers. These include atropine, cyclopentolate, homatropine, scopolamine and tropicamide. They are indicated for use in cycloplegic refraction (to paralyze the ciliary muscle in order to determine the true refractive error of the eye) and the treatment of uveitides/ uveitis. All cycloplegics are also mydriatic (pupil dilating) agents and are used as such during eye examination to better visualize the retina.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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