Asthenopia

Saudi Journal of Ophthalmology

Volume 26, Issue 3 , Pages 339-341, July 2012
Asthenopia as the presenting symptom in advance allergic
fungal sinusitis
Abdullah A. Alsagoob, MBBS
,
Abdel . !agu"#, $%&S'd ()*h+h,
,
Ahmed -. Al-Ahma"y, M.
,
/am#s M. Sa"#, $%&S
.e*a"+me0+ o1 Su"ge"y, Imam Abdul"ahma0 B#0 $a#sal os*#+al, .ammam, Saud# A"ab#a
%e2e#3ed 24 July 20115 a22e*+ed 4 $eb"ua"y 2012.
Abstract
$ull !e6+
P.$
Images
%e1e"e02es
Abstract
A 14-year-old male presented to the ophthalmology clinic with a history of asthenopia. Laboratory, radiological and
histopathological studies confrmed the diagnosis of allergic fungal sinusitis resulting in lateral displacement of the
medial rectus muscles. Symptoms improved and near point of convergence recovered after surgical endoscopic
decompression of the ethmoidal and maxillary sinuses.
Keywords: Allergic fungal sinusitis, Asthenopia, Convergence, Paranasal sinuses
http://www.saudiophthaljournal.com/article/S1319-4534(12)00029-/a!stract
US National Research Council mendefenisikan asthenopia sebagai suatu gejala
subjektif penglihatan yang disebabkan karena penggunaan mata (dalam pekerjaan)
(Suharyanto, 1!)" #alam $amus ilmiah penglihatan, asthenopia didefinisikan sebagai keluhan
subjektif penglihatan berupa penglihatan tidak nyaman, sakit dan kepekaannya berlebihan"
%enurut dr" &di Supiandi 'ffandi, Sp% dari bagian (lmu )enyakit %ata *$U(, asthenopia adalah
gejala yang diakibatkan oleh upaya yang berlebihan dari sistem penglihatan yang berada dalam
kondisi kurang sempurna untuk memperoleh ketajaman penglihatan ($oesyanto, +,,-)"
$elelahan mata yang juga dikenal sebagai asthenopia merupakan kelelahan okular atau
ketegangan pada organ .isual dimana terjadi gangguan pada mata dan sakit kepala
sehubungan dengan penggunaan mata secara intensif" $eletihan .isual menggambarkan
seluruh gejala/gejala yang terjadi sesudah stress berlebihan terhadap setiap fungsi mata,
diantaranya adalah tegang otot siliaris yang berakomodasi saat memandang objek yang sangat
kecil dalam jarak yang sangat dekat"
'sthenopia sering pula diistilahkan dengan Computer Eye Syndrome. Computer Eye
Syndrome merupakan suatu keadaan mata yang bermanifestasi tidak spesifik seperti 0 lelah,
nyeri, penglihatan kabur, sakit kepala dan sebagainya akibat penggunaan komputer yang
berlebihan"
1erdapat tiga jenis asthenopia yaitu 0 Asthenopia Acomodatif, Asthenopia Muscular, dan
Asthenopia Neurastenik" 'sthenopia pada operator komputer merupakan Asthenopia
Acomodatif yang disebabkan oleh kelelahan otot siliaris(2anum, +,,3)"
Untuk $elanjutannya silahkan lihat pada link berikut
ini 0 http044555"jurnalkesehatanmasyarakat"blogspot"com4+,1+4,14penyebab/asthenopia"html
http044jurnalkesehatanmasyarakat"blogspot"com4+,1+4,14pengertian/asthenopia"html
)enyebab utama astenopia adalah kelelahan pada ciliary dan extraoculer otot akibat akomodasi
penglihatan jarak dekat dalam 5aktu lama" *aktor penyebab lainnya adalah kekeringan pada
mata akibat peningkatan ekspos pada permukaan kornea ketika fokus melihat ke depan dan
kurangnya frekuensi berkedip ('malia 2", et"al, +,1,)" $elelahan pada mata akibat fokus pada
objek berjarak dekat dalam 5aktu lama disebabkan karena otot/otot mata harus bekerja lebih
keras untuk melihat objek berjarak sangat dekat, terutama jika disertai dengan pencahayaan
yang menyilaukan (2anum, +,,3)"
)ada jenis pekerjaan tertentu ada kecenderungan penggunaan akomodasi mata yang
berlebih (terus menerus) terutama pada pekerjaan yang membutuhkan penglihatan dengan
jarak dekat atau menengah, sebagai contoh operator kontrol, pekerja yang menggunakan
komputer, penjahit, reparasi jam, dan lain/lain" 6ika hal ini berlangsung lama maka akan
menimbulkan kelelahan mata ('sthenopia atau eyestrainatau eye fatigue) yang berlanjut pada
gangguan penglihatan permanent seperti kelainan refraksi ()hesant, 11 dalam 2aeny,
+,,)" $elelahan pada mata juga bisa disebabkan oleh pemakaian komputer yang dipengaruhi
penerangan dan jarak pandang yang tidak sesuai kebutuhan ($oesyanto, +,,-)"
Untuk mengetahui apa yang dimaksud dengan asthenopia silahkan cek pada link berikut
ini 0 http044555"jurnalkesehatanmasyarakat"blogspot"com4+,1+4,14pengertian/asthenopia"html
Asthenopia
$"om 7#8#*ed#a, +he 1"ee e02y2lo*ed#a
Asthenopia
Classification and external resources
ICD-10 93.1
ICD-9 364.13
Asthenopia (aes+he0o*#a,1"om +he :"ee8 ;o"d <as+he0-o*#a = >?@AB-CDE>< o" eye
strain #s a0 o*h+halmolog#2al 2o0d#+#o0 +ha+ ma0#1es+s #+sel1 +h"ough0o0s*e2#1#2
sym*+oms su2h as 1a+#gue, *a#0 #0 o" a"ou0d +he eyes, blu""ed 3#s#o0, heada2he a0d
o22as#o0al double 3#s#o0. Sym*+oms o1+e0 o22u" a1+e" "ead#0g, 2om*u+e" ;o"8, o"
o+he" 2lose a2+#3#+#es +ha+ #03ol3e +ed#ous 3#sual +as8s.
7he0 2o02e0+"a+#0g o0 a 3#sually #0+e0se +as8, su2h as 2o0+#0uously 1o2us#0g o0 a
boo8 o" 2om*u+e" mo0#+o", +he 2#l#a"y mus2le +#gh+e0s. !h#s 2a0 2ause +he eyes +o ge+
#""#+a+ed a0d u02om1o"+able. :#3#0g +he eyes a 2ha02e +o 1o2us o0 a d#s+a0+ obFe2+ a+
leas+ o02e a0 hou" usually alle3#a+es +he *"oblem.
A &%! 2om*u+e" mo0#+o" ;#+h a lo; "e1"esh "a+e (GH0I, o" a &%! +ele3#s#o0 2a0
2ause s#m#la" *"oblems be2ause +he #mage has a 3#s#ble 1l#28e". Ag#0g &%!s also o1+e0
go sl#gh+ly ou+ o1 1o2us, a0d +h#s 2a0 2ause eye s+"a#0. /&.s do 0o+ go ou+ o1 1o2us
a0d a"e less sus2e*+#ble +o 3#s#ble 1l#28e".
A *age o" *ho+og"a*h ;#+h +he same #mage +;#2e sl#gh+ly d#s*la2ed (1"om a *"#0+#0g
m#sha*, o" a 2ame"a mo3#0g du"#0g +he sho+ as #0 +h#s #mage, 2a0 2ause eye s+"a#0 by
+he b"a#0 m#s#0+e"*"e+#0g +he #mage 1aul+ as d#*lo*#a a0d +"y#0g #0 3a#0 +o adFus+ +he
s#de;ays mo3eme0+s o1 +he +;o eyeballs +o 1use +he +;o #mages #0+o o0e.
Causes
Some+#mes, as+he0o*#a 2a0 be due +o s*e2#1#2 3#sual *"oblems, 1o" e6am*le,
u02o""e2+ed "e1"a2+#o0 e""o"s o" b#0o2ula" 3#s#o0 *"oblems su2h as a22ommoda+#3e
#0su11#2#e02y o" he+e"o*ho"#a. I+ #s o1+e0 2aused by +he 3#e;#0g o1 mo0#+o"s su2h as
+hose o1 2om*u+e"s o" *ho0es.
See also
&om*u+e" 3#s#o0 sy0d"ome
Pho+o*hob#a
'ye e6am#0a+#o0
V#s#o0 +he"a*y
As+#gma+#sm
!ternal lin"s
Mayo &l#0#2 e0+"y o0 'yes+"a#0
%e+"#e3ed 1"om <h++*=JJe0.;#8#*ed#a.o"gJ;J#0de6.*h*K
+#+leLAs+he0o*#aMold#dL6191604HH<
&a+ego"#es=
V#sual d#s+u"ba02es a0d bl#0d0ess
!h#s *age ;as las+ mod#1#ed o0 1 July 2014 a+ 14=36.
!e6+ #s a3a#lable u0de" +he &"ea+#3e &ommo0s A++"#bu+#o0-Sha"eAl#8e /#2e0se5
add#+#o0al +e"ms may a**ly. By us#0g +h#s s#+e, you ag"ee +o +he !e"ms o1
Nse a0d P"#3a2y Pol#2y. 7#8#*ed#aO #s a "eg#s+e"ed +"adema"8 o1
+he 7#8#med#a $ou0da+#o0, I02., a 0o0-*"o1#+ o"ga0#Ia+#o0.
http://en.wi"ipedia.or#/w/inde$.php%title&'sthenopia(printa!le&)es
Management of asthenopia
#atient history and e!amination
#ersons $ho ha%e signs and symptoms that indicate asthenopia should ha%e a thorough
%ision e!amination &'able ()* &It is also important to assess musculos"eletal complaints+ so
that healthcare professionals can determine if there is an association $ith %isual problems
and if further e%aluation is needed for nonoptical complaints)* ,hene%er it is difficult to
decide $hether a patient-s asthenopia is caused by muscular or refracti%e factors+ the
patient may be ad%ised to $ear an occlusi%e patch o%er one eye for se%eral days* If the
patch test relie%es the symptoms+ asthenopia is most li"ely caused by muscular factors*
.
ye specialists $ill need to decide if treatment+ usually optical correction+ is specific to the
computer tas" or $hether the same glasses or treatment $ould be re/uired for general
%ision needs* ye conditions+ such as presbyopia+ astigmatism+ myopia+ dry eye and others+
are said to be computer-related if the symptoms occur most often during+ or are $orsened
by+ computer $or"*
00
&It is not unusual+ ho$e%er+ for persons older than (0 to de%elop
presbyopia+ regardless of time spent at a computer screen*) If correcti%e lenses are
prescribed+ it is important that the patient be fitted on the intended use of the glasses1
people read at a different angle and distance from the manner in $hich they %ie$ a
computer screen* %en though both acti%ities in%ol%e close $or"+ it is possible that t$o
different prescriptions $ill be needed for reading printed pages and for %ie$ing a computer
monitor*

Optical treatments
In addition to optical correction &i*e*+ lenses+ prisms)+ other treatments include %ision
therapy &to address problems of accommodation+ %ergence and accommodati%e2%ergence
interaction)+ medical &pharmacologic agents) and surgery &e!traocular surgery for
strabismic and large angle nonstrabismic %ergence defects)* 3ision therapy is aimed at
increasing the amplitude+ speed+ accuracy and ease of accommodati%e response &i*e*+
/uic"er and more accurate focus)4 %ergence therapy is aimed at enhancing sensorimotor
fusion &or+ a more precise and stabili5ed retinal image)*
6
Impro%ement of both the accommodati%e and %ergence adaptation systems is necessary for
successful %ision therapy because these systems are the most important for a person-s long-
term comfort* 'herapy is directed+ first+ at impro%ing refle!-fast fusional %ergence+ then at
e!panding slo$ %ergence responses+ and in the process+ accommodati%e fle!ibility is also
restored* 'he last stage of therapy enhances the fle!ibility bet$een accommodation and
%ergence* 'he goal of %ision therapy is re-establishment of automatic+ effortless
accommodati%e and %ergence responses under all conditions* Impro%ement of amplitudes
alone is not sufficient*7
8edical therapy for patients $ho ha%e been diagnosed $ith dry eye include topical
lubricants+ cyclosporine A ophthalmic emulsion &9estasis)+ punctual occlusion and systemic
therapy for dry eye or blepharitis*
1.
Surgical indications for dry eye syndrome may also be efficacious in patients $ith
computer %ision syndrome4 some patients may benefit from punctual plug insertion*1. In
general+ e!traocular muscle surgery is rarely ad%ocated to treat non-strabismic %ergence
defects* It should be considered only $hen optical correction or %ision therapy methods
ha%e failed and a significant heterophoria &a condition in $hich eyes de%iate from
parallelism) continues to produce symptoms* 'here is no surgery a%ailable for
accommodati%e dysfunction*
7

Antio!idant treatments
As antio!idant nutrients are being found to play a role in the pre%ention and treatment of
%arious chronic diseases+ including asthma+ cardio%ascular disease and cancer+ they are also
being studied in eye diseases+ such as cataracts and age-related macular degeneration
&A8D)*0:-07 One category of antio!idants+ "no$n as carotenoids+ may be particularly
helpful* Carotenes &alpha-carotene and beta-carotene) and !anthophylls &asta!anthin+
lutein and 5ea!anthin) are the t$o general classes of carotenoids*
'he ;ational ye Institute-sponsored Age 9elated ye Disease Study has found that ta"ing
high le%els of %itamins C and + beta-carotene and 5inc can reduce the ris" of de%eloping
A8D by about 0< percent*
06
'he !anthophylls+ lutein &=>') and 5ea!anthin &?A)+ $hich
are the only carotenoids located in the eye+ may protect against cataracts and A8D* One of
the first large studies on carotenoids $as the ye Disease Case Control Study+ in $hich the
relationships bet$een dietary inta"e of carotenoids and %itamins A+ C and and the ris" of
for de%eloping A8D $ere assessed* 9esults found a significantly lo$er ris" for de%eloping
A8D in people $ith high amounts of =>' and ?A in their blood* Additionally+ data from
the ;urses- @ealth Study sho$ed a decreased li"elihood of cataract surgery $ith increasing
inta"es of =>' and ?A*
0.

#otential treatment for eye fatigue
Another !anthophyll is asta!anthin+ $hich is the pin" and red pigment found in salmon+
shrimp and lobster4 other sources are microalgae+ red yeast and crustacean byproducts+
such as mineral salts* 'his carotenoid is being studied to determine its effect in
cardio%ascular health+ inflammation and eye disorders* 8ost of the research has been done
regarding asta!anthin-s role in alle%iating eye fatigue &'able <)*
In animal studies+ asta!anthin has limited e!ercise-induced s"eletal and cardiac muscle
damage in mice+ sho$ed an ocular anti-inflammatory effect in rats and reduced ocular
inflammation in rats $ith endoto!in-induced u%eitis*
09+:0+:1
A study by 8c;ulty and colleagues measured the effects of %arious carotenoids on rates of
lipid pero!idation and correlated these findings $ith their membrane interactions*
Asta!anthin preser%ed membrane structure and e!hibited significant antio!idant acti%ity*
:0
Se%en studies ha%e e!amined the effects of asta!anthin on accommodation and %isual
function* As discussed earlier+ accommodati%e dysfunction is the inability of the eye to focus
clearly on obAects at %arying distances* 'his dysfunction can present in %arious $ays+
including accommodati%e spasm &o%er-stimulation of the parasympathetic ner%ous system
that may result in ocular fatigue) and poorly sustained accommodation+ in $hich the
amplitude of accommodation is normal but fatigue results from continuous accommodati%e
stimulation* &'he amplitude of accommodation is the range of focal po$ers4 this range
declines $ith age*)
;aga"i+ et al+ e!amined the effect of < mg asta!anthin &or placebo) daily for four $ee"s in
06 3D' $or"ers* @alf recei%ed the study drug and half too" the placebo* &A third group of
non-3D' $or"ers also recei%ed placebo*):: 'he participants $ho too" the study drug
e!perienced impro%ed accommodation amplitude* 'he authors noted that because
accommodation amplitude %aries $ith age+ and diabetes is a ris" factor for reduced
accommodati%e amplitude+ ages $ere matched in the study groups+ and people $ith
diabetes $ere e!cluded from the study*
In (9 people &all age (0 years and older)+ none of $hom $ere 3D' $or"ers+ ;a"amura+ et
al+ e%aluated the effect of asta!anthin on %isual function*:( Bour groups matched for age
and gender+ too" the placebo or 0 mg+ ( mg+ or 10 mg daily for 0. consecuti%e days*
>ncorrected far %isual acuity impro%ed significantly and positi%e accommodation time
shortened significantly in the participants ta"ing ( mg or 10 mg*
Shiratori+ et al+ recruited (0 subAects $ho complained of eye strain+ did not ha%e organic
eye disease and used a computer daily*
:<
'he 00 participants $ho too" the study drug &6 mg
asta!anthin daily for four $ee"s) demonstrated a significantly higher rate of positi%e and
negati%e accommodation time &e*g*+ rate of change) compared $ith the placebo group and
impro%ement in t$o symptoms of asthenopia &bleary eyes and irritated easily)* &3isual
analogue scale C3ASD measurements consisted of 1: items+ nine concerning the eyes and
four about general physical condition*) 'he in%estigators concluded that asta!anthin at the
dosage administered impro%ed accommodation po$er and subAecti%e symptoms of
asthenopia*
;aga"i+ et al+ e!amined <9 3D' $or"ers $ho used a computer at least si! hours per day
and complained of asthenopia on a daily basis*:6 After four $ee"s of treatment &6 mg
asta!anthin or placebo daily)+ the researchers found that accommodation time impro%ed
significantly in the treatment group compared $ith the placebo group* In response to a
subAecti%e /uestionnaire e%aluating asthenopic symptoms+ the treatment group sho$ed a
significant reduction in complaints of Ehea%y head+EEdim sight+Eand Estiff shoulders and
bac"*E
'en people $ere recruited for a study to assess if asta!anthin assisted accommodati%e
reco%ery produced by rest after 3D' $or"4 the study participants too" 6 mg asta!anthin
daily for t$o $ee"s*
:7
'he subAects responded to a /uestionnaire regarding their eye fatigue
before 3D' $or"+ after 3D' $or" and after rest* ;ana"o+ et al+ concluded that
asta!anthin aids the accommodati%e reco%ery process and acts to eliminate fatigue*
;itta+ et al+ assessed the effect of asta!anthin for four $ee"s on :0 3D' $or"ers &$ho spent
F7 hours2day using 3D's)*
:.
Di%ided into three groups+ 10 people recei%ed 6 mg
asta!anthin+ 10 recei%ed 10 mg asta!anthin and 10 too" a placebo* At the end of the study
period+ accommodation in the 10-mg group increased significantly4 positi%e
accommodation time $as shortened significantly in the 6-mg and 10-mg groups4 negati%e
accommodation time $as significantly shortened in the placebo and 6-mg groups*
According to 3AS assessment+ many subAecti%e symptoms impro%ed in the 6-mg group*
I$asa"i+ et al+ enrolled 10 subAects in a study of 6 mg2day asta!anthin or placebo for t$o
$ee"s+ after $hich the participants performed a near %isual tas" for 00
minutes*
:9
Accommodati%e function and subAecti%e symptoms related to eye strain $ere
assessed before and after the tas"+ and follo$ing a 10-minute rest after the tas"* After the
tas"+ accommodation contraction and rela!ation times $ere e!tended in both the
asta!anthin and placebo groups4 accommodation rela!ation time $as significantly
e!tended in the placebo group compared $ith the asta!anthin group* Accommodati%e
contraction and rela!ation time $ere significantly prolonged after the 10-minute rest
period in the placebo group compared $ith the treatment group* Symptoms of eye fatigue+
eye hea%iness+ blurred %ision and dry eye $ere increased in the placebo group4 in the
asta!anthin group+ eye fatigue and eye hea%iness increased* 'he in%estigators concluded
that asta!anthin is effecti%e in reducing and pre%enting eye strain resulting from
accommodati%e dysfunction*
'hree studies assessed retinal blood flo$+ high-dose administration of asta!anthin and the
benefits of asta!anthin for sports performance* In an e!amination of retinal blood flo$ in
:6 subAects $ho too" asta!anthin &6 mg daily for four $ee"s) or placebo+ ;aga"i+ et al+
determined that asta!anthin supplementation may increase retinal blood flo$*
(0
'he fasting
plasma asta!anthin le%el in the asta!anthin group $as significantly higher than before
supplementation4 the fasting plasma asta!anthin le%el in the placebo group after placebo
treatment group $as unchanged* After four $ee"s of treatment+ retinal capillary blood flo$
in the asta!anthin group $as significantly higher than before supplementation in both eyes+
$hile retinal capillary blood flo$ in the placebo group $as unchanged* Intraocular
pressures in both groups $ere unchanged*
Ohgami+ et al+ assessed the safety of high-dose asta!anthin in 10 %olunteers $ho too"
asta!anthin 1< mg t$ice daily for four $ee"s*
(1
'he subAects under$ent physical and
ophthalmological e!aminations before beginning the study+ after the second and fourth
$ee"s of the study+ and at t$o and four $ee"s follo$ing completion of the study* ;o
clinically significant abnormal changes $ere obser%ed+ and no ad%erse effects as a result of
ta"ing asta!anthin $ere found*
Sa$a"i+ et al+ studied the effects of asta!anthin &6 mg daily) or placebo on %isual acuity and
sports performance in 1. college handball players and 16 college distance runners*
(0
In the
handball players+ the deep %ision and the critical flic"er fusion of the treated groups $ere
significantly impro%ed compared to the control group* In the distance runners+ serum lactic
acid concentration at t$o minutes after acti%ity in the treated group $as significantly lo$er
than in the control group* 'he in%estigators concluded that asta!anthin supplementation is
effecti%e for the impro%ement of %isual acuity and muscular fatigue that may lead to better
sports performances*
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