Case Study: Chronic Eye Pain and Accommodative Spasm in an 18-Year-Old Male with a History of Neonatal Intraventricular Hemorrhage
Case at a Glance
An 18-year-old male with a history of Grade II intraventricular hemorrhage at birth and congenital nystagmus presents with chronic, debilitating eye pain and accommodative spasm. His condition is refractory to standard therapies, significantly impacting his quality of life and academic pursuits.
Patient's Story
The patient is an 18-year-old male student who reports a lifelong struggle with visual disturbances stemming from a Grade II intraventricular hemorrhage (IVH) sustained at birth. This resulted in congenital nystagmus. While other neurological issues are reportedly minimal, his primary burden is constant and severe eye pain, which has become a significant barrier to his education and daily activities.
Initial Assessment
The patient presented with a chief complaint of constant, bilateral eye pain. He described the sensation as a persistent dull ache, pressure, and tension 'in' and 'behind' the eyes. Symptoms are exacerbated significantly by near-work activities such as reading or using digital screens, leading to rapid eye fatigue. He noted that when the pain intensifies, it often radiates, causing secondary tension headaches.
The Diagnostic Journey
The patient sought multiple consultations with both ophthalmology and neurology. Clinical examinations confirmed the presence of congenital nystagmus. Further investigation into his symptoms of pain and strain led to a diagnosis of accommodative spasm, a condition where the eye's ciliary muscle remains in a state of persistent contraction. The neonatal IVH was considered the likely root cause of his complex neuro-ophthalmological presentation.
Final Diagnosis
Chronic Accommodative Spasm and Congenital Nystagmus, secondary to sequelae of neonatal Grade II Intraventricular Hemorrhage.
Treatment Plan
Several management strategies have been attempted with limited success:
- Pharmacotherapy: Cycloplegic eye drops were prescribed to paralyze the ciliary muscle. The patient reported this provided effective but only temporary relief from the pain and spasm. He was advised this might be a lifelong requirement for symptomatic control.
- Vision Therapy: A regimen of eye exercises was implemented but provided no discernible benefit.
- Nutritional Supplements: The patient self-initiated trials of magnesium and other general supplements without any effect on his symptoms.
Outcome and Follow-up
The patient's condition remains a significant daily challenge. The chronic pain and inability to sustain focus for near-work severely impact his academic performance and social life. He feels he has reached a therapeutic ceiling with conventional treatments and is distressed by the prospect of relying on cycloplegic drops indefinitely. The patient is actively seeking alternative or adjuvant long-term management strategies that could offer more sustainable relief and improve his functional capacity.