Session: Poster session A

Spasm of the near reflex in a patient with chronic intestinal pseudo-obstruction

Maria Immacolata MESIANI ^1,2, Matilde RODA^1,2, Costantino SCHIAVI ^1,2, Nicola VALSECCHI ^1,2, Eleonora TROLLI^1,2, Michela FRESINA^1,2

¹Alma Mater Studiorum University of Bologna, Bologna (BO), Italy
²IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna (BO), Italy

Introduction

The aim is to question about the association between spasm of the near reflex (SNR) and chronic intestinal pseudo-obstruction (CIPO).

Case report

A 17-year-old woman, suffering from CIPO, was referred to our ER because of the recent onset of diplopia and blurry vision.

Her visual acuity (VA) was 20/30. Dynamic retinoscopy showed a variable refraction from -5.00 to -1.25 in the and from -3.00 to -0.75 in the OS, while after cycloplegic eyedrop instillation the refraction was +0.25 -1,25/170° RE and +0.75 -1/175° (T) LE. ERG and VEP, laboratory tests, neurological exams, CT brain and MRI brain did not show anomalies and a subsequent visit confirmed the retinoscopy findings.

A therapy with atropine drops was set and lenses for far vision and for near vision were prescribed.

At subsequent monthly follow-up visits, VA and refraction were fluctuating and she reported symptoms relief with drops and worsening without. Therefore, the eye therapy was stopped and patient was referred to the psychiatrist.

Discussion

Primary SNR generally affects young women with uncorrected hypermetropia and is often psychogenic in origin.

Our patient was a young woman with an inconstant pseudomyopia and clear stressfull triggers, so she appeared to have a primary SNR. Despite this, her systemic pathology raised the doubt of an organic pathogenesis.

The etiology of CIPO is unknown, but altered levels of acetylcholine, secreted by the myenteric plexus and increasing the tone and amplitude of pendular movements of the gut, due to low acetylcholinesterase activity and a reduction of ganglion cells, have been found in neurodegenerative intestinal hypoganglionosis.

Moreover, acetylcholine is responsible for accommodation and pupil constriction.

Conclusions

Excessive neurostimulation mediated by acethilcoline could be one of the mechanisms underlying both SNR and CIPO.

However, it remains unclear why symptoms were discontinuous and why only the intestinal and intrinsic ocular muscles were involved.