One side effect of cycloplegic drops is that they often have BAK as a preservative ingredient, which, with daily use, can erode the tear shield:

At each administration of an eye drop containing benzalkonium chloride, its detergent effect disrupts the lipid layer of the tear film. This cannot be regenerated and can no longer protect the aqueous layer of the tear film, which evaporates easily. In these circumstances, the cornea is exposed and eye dryness occurs. In addition, benzalkonium chloride has a cellular toxicity on caliciform cells, entailing a reduction in the amount of mucin, an additional reason for disrupting the tear film. In fact, none of the cycloplegic drops used to treat Spasm of Accommodation in the United States are available without BAK. This unfortunately makes treatment much more difficult as the side effect of dry eyes and corneal damage can occur. France, Australia, Canada, and the United Kingdom do have limited availability of BAK-free eye drops available in unidose, and they must be imported to the United States with a physicians letter to the FDA enclosed with the imported prescription. Due to the high potential of tear shield damage with long-term use and the associated dry eye condition caused by cycloplegic eye drops with BAK (preservative), many physicians do not recommend cycloplegic eye drops.
New studies conducted on rats using perilla frutescens aqueous extract have shown to relax the ciliary muscle. Since there are no known drugs to treat this eye condition, perilla frutescens in an aqueous extract form may result in the relaxation of the ciliary muscle in humans as well. Perilla frutescens is currently used in traditional medicine in Korea, Japan, and China and a clinical study "showed that PFA (perilla frutescens extract) attenuates eye fatigue by improving visual accommodation"

Prognosis
For routine cases of spasm of accommodation, the American Optometric Association says the prognosis is fair and on average, the number of visits a patient needs will be 1-2 for evaluation and 10 follow up visits. Additionally, the AOA recommends the following management plan for spasm of accommodation: "Begin with plus lenses and VT; if VT fails, use cycloplegic agent temporarily; educate patient".For more chronic and acute cases that do not respond to vision training and cycloplegic drops, the eye muscles should weaken with advancing age providing intermittent or permanent relief from this condition. See also
Miosis
Cycloplegia
Pseudomyopia


== References ==