In difficult cases, "cycloplegic agents are highly favored to break spasm quickly and may be more economical compared to other conventional therapies"Cyclopentolate, Atropine, Tropicamide, and Homatropine are the typical cycloplegic eye drops used once daily to treat spasm of accommodation by relaxing the ciliary muscle. One side effect is blurred vision since these induce dilation. Vision Training
Vision therapy administered by a trained optometrist has shown a success rate of over 70%. Surgery
Multifocal intraocular lens implantation is a new possible treatment involving clear lens extraction and multifocal intraocular lens implantation but it may not be appropriate for patients who have had resistant spasm of accommodation for a long period of time. Research
Experimental Nitroglycerin and Nitric Oxide
Animal studies have found nitroglycerin, a vasodilator used to treat angina, relaxes the ciliary muscle and may hold hope for those suffering from spasm of accommodation. Nitroglycerin is currently being investigated as a treatment for glaucoma, and has shown to decrease intraocular pressure and relax the ciliary muscle. According to Investigative Ophthalmology & Visual Science Journal. "In a nonhuman primate study, topical administration of nitroglycerin at a dose of 0.1% significantly decreased IOP in normotensive animals after 90 minutes". Further, according to Wiederholt, Sturm, and Lepple-Wienhues, "The data indicate (indicates [sic]) that an increase of intracellular cGMP by application of cGMP and organic nitrate or non-nitrate vasodilators induces relaxation of the bovine trabecular meshwork and ciliary muscle". Experimental Perilla frutescens
Since spasm of accommodation is a result of contraction of the ciliary muscle, the goal would be to relax the ciliary muscle.
Porcelain veneers on the incisors are particularly vulnerable to damage, and sometimes a crown can be perforated by occlusal wear. Occlusal splints (also termed dental guards) are commonly prescribed, mainly by dentists and dental specialists, as a treatment for bruxism. Proponents of their use claim many benefits, however when the evidence is critically examined in systematic reviews of the topic, it is reported that there is insufficient evidence to show that occlusal splints are effective for sleep bruxism as well as bruxism overrall. Furthermore, occlusal splints are probably ineffective for awake bruxism, since they tend to be worn only during sleep. However, occlusal splints may be of some benefit in reducing the tooth wear that may accompany bruxism, but by mechanically protecting the teeth rather than reducing the bruxing activity itself. In a minority of cases, sleep bruxism may be made worse by an occlusal splint. Some patients will periodically return with splints with holes worn through them, either because the bruxism is aggravated, or unaffected by the presence of the splint. When tooth-to-tooth contact is possible through the holes in a splint, it is offering no protection against tooth wear and needs to be replaced. Occlusal splints are divided into partial or full-coverage splints according to whether they fit over some or all of the teeth. They are typically made of plastic (e.g. acrylic) and can be hard or soft. A lower appliance can be worn alone, or in combination with an upper appliance.