Rare case of accommodative loss after barrage laser in myopic eyes and the novel method of rehabilitation using topical pilocarpine

Accommodation is mediated by the short posterior ciliary nerves (SPCN) through muscarinic innervation to ciliary muscles. We report a case of an 18-year female who presented with glare and loss of near vision in both eyes after barrage laser to the peripheral retina for multiple lattices with atrophic holes. Before laser, both eyes (OU) best corrected visual acuity (BCVA) with myopic correction was 20/20. After 1 week post-laser, near vision decreased to OU N18, and pupils were dilated and sluggishly reacting. A working diagnosis of bilateral accommodative and pupillary paralysis secondary to laser-induced damage to SPCN was made. We rehabilitated her with topical 1% pilocarpine drops for a month and she recovered. This is one of the few case reports of internal ophthalmoplegia following a barrage laser in a myopic patient. Another uniqueness is the use of 1% pilocarpine drops as a temporary rehabilitation for near vision correction.