Presentation
IDF typically presents as a solitary painless, smooth, flesh-colored to red, dome-shaped nodule located on the dorsal or lateral aspect of a finger or toe but sparing the thumb or great toe; they occur principally in the first two years of life with about 1/3 of cases having a lesion since birth. However: 1) lesions with appearances similar to, and diagnosed as, IPF have been described in extra digital sites such as the arm, breast, tongue, thigh, and chest; 2) unusual cases have presented with multiple lesions, i.e. 2–3, uncommonly 7–15, and one case with 74 lesions in a 2018 review study; 3) cases have been reported in children up to the age 10 and one case was reported in a 52-year-old adult; 4) the lesions are typically smaller than 2 cm in maximum diameter but rarely have been tumor-sized, e.g. 4.5 cm; 5) the lesions, particularly when larger-sized, may be painful and/or compromise the functions of nearby joints and digits; and 6) the lesions occasionally invade the periosteum and erode a nearby bone. Pathology
Microscopic histopathological analyses of appropriately dye-stained IDF tissues typically show a non-encapsulated small tumor composed of bundles of uniform spindle-shaped cells that combine physical features of fibroblasts (the most common cell type in connective tissue) with those of myofibroblasts  (contractile, spindle-shaped cells that are identifiable by their expression of α-smooth muscle actin) in a background of collagen fibers. In hematoxylin and eosin-stained tissues, the spindle-shaped cells have pale eosinophilic (i.e.
In ophthalmology, accommodative excess (also known as excessive accommodation or accommodation excess) occurs when an individual uses more than normal accommodation (focusing on close objects) for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patients age. Modern definitions simply regard it as an inability to relax accommodation readily. Excessive accommodation is seen in association with excessive convergence also. Symptoms and signs
Blurring of vision due to pseudomyopia
Headache
Eye strain
Asthenopia
Trouble concentrating when reading

Causes
Causes related to refractive errors
Accommodative excess may be seen in the following conditions:
Hypermetropia: Young hypermetropes use excessive accommodation as a physiological adaptation in the interest of clear vision. Myopia: Young myopes performing excessive near work may also use excessive accommodation in association with excessive convergence. Astigmatism: Astigmatic eye may also be associated with accommodative excess. Presbyopia: Early presbyopic eye may also induce excessive accommodation. Improper or ill fitting spectacles: Use of improper or ill fitting spectacles may also cause use of excessive accommodation. Causes related to systemic drugs
Use of systemic drugs like Morphine, Digitalis, Sulfonamides, Carbonic anhydrase inhibitors may cause accommodative excess. Causes related to diseases
Unilateral excessive accommodation-Trigeminal neuralgia, and head trauma may cause ciliary spasm and may cause accommodative excess. Bilateral excessive accommodation-Diseases like Encephalitis, Syphilis, Head trauma, Influenza, Meningitis may cause ciliary spasm and bilateral excessive accommodation. Secondary to Convergence insufficiency
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce.