A Case Presentation of Unilateral Post-Traumatic Pseudomyopia

Title A Case Presentation of Unilateral Post-Traumatic Pseudomyopia
Author, Co-Author Ami Halvorson, Kirk Halvorson
Topic
Year
2014
Day
Friday
Program Number
145277
Room
Four Seasons Ballroom
Affiliation
Pacific University College of Optometry
Abstract Background: This case report describes a patient who presented with monocular blurred vision and periocular pain secondary to a motor vehicle accident (MVA).

Case Report: A 40-year-old black female presented with blurred distance vision and periocular pain of the left eye only following a MVA where she was struck as a pedestrian two months prior. Subsequent imaging of the brain revealed “..a small cavernoma present in association with a developmental venous anomaly.” All follow up imaging proved to be stable to the original scans.

At the time of her eye exam, her ocular history was unremarkable. Her medical history was positive for depression, post-traumatic stress disorder and the concussion that she suffered as a result of the MVA. The patient was taking Lexapro and bupropion. She was not a smoker and reported only social drinking with no drug use.

The patient’s unaided distance visual acuities were OD: 20/15- and OS: 20/200 PH 20/20. Her unaided near visual acuities were OD 20/20 and OS 20/20.

Dry Retinoscopy
OD Plano -0.50 x 080 20/20
OS -2.25 -0.50 x 140 20/20

Damp Retinoscopy
OD +0.75-0.75 x 075 20/20
OS Plano -0.50 x 113 20/20

Examination of the anterior and posterior segment was unremarkable OU. The patient was referred to neuro-ophthalmology, where a battery of supplemental testing proved to be normal and a diagnosis of post-traumatic pseudomyopia was confirmed. The patient was treated with atropine for the accommodative symptoms and gapentin for the periocular pain. She was followed for nearly a year until the symptoms finally relented.

Conclusion/Discussion: The ocular sequelae resulting from a traumatic brain injury (TBI) can have a profound impact on a patient’s life in many facets, including occupation, driving, ambulation, and many other activities of daily living. Literature has shown that patients can have a pseudomyopic refractive error shift following a TBI. The basis for the accommodative spasm isn’t clear but it is postulated to be the result of disinhibition of the accommodative center in the brain stem or neural irritation of the accommodative portion of the parasympathetic third nerve subnucleus.
Affiliation of Co-Authors Pacific University College of Optometry
Outline