In paralysis of accommodation, the phenomenon can be described as:

In paralysis of accommodation, the phenomenon can be described as:

• A. Can be bilateral or unilateral
• B. Always unilateral
• C. Always bilateral
• D. Only in systemic disease

Answer: (A)

Paralysis of accommodation reflects a disruption in the parasympathetic input to the ciliary muscle that controls focusing of the lens. The near response involves both eyes, so if the lesion is localized to one side (for example, a unilateral impairment of the oculomotor nerve’s parasympathetic fibers or the ciliary ganglion), accommodation can be lost in the affected eye while the other eye still functions. If the lesion is bilateral or widespread—such as systemic pharmacologic cycloplegia or a bilateral central disruption—the inability to accommodate can involve both eyes. Thus, this phenomenon can be seen as either bilateral or unilateral depending on where the disruption occurs.

Paralysis of accommodation reflects a disruption in the parasympathetic input to the ciliary muscle that controls focusing of the lens. The near response involves both eyes, so if the lesion is localized to one side (for example, a unilateral impairment of the oculomotor nerve’s parasympathetic fibers or the ciliary ganglion), accommodation can be lost in the affected eye while the other eye still functions. If the lesion is bilateral or widespread—such as systemic pharmacologic cycloplegia or a bilateral central disruption—the inability to accommodate can involve both eyes. Thus, this phenomenon can be seen as either bilateral or unilateral depending on where the disruption occurs.