Sudden loss of accommodation can result from numerous etiologies, including head trauma, encephalitis, oculomotor nerve palsy, uveitis, and viral diseases.1 Many drugs, such as tricyclic antidepressants and phenothiazines, also cause acute accommodation paresis.2 However, to our knowledge, lorazepam-induced accommodation paresis has never been reported.
A 23-year-old man complained of near-sight disturbance. He had been taking lorazepam (Ativan) 1.5 mg/day and fluoxetine 10 mg/day during the past 2 weeks because of depression. At 5 days after taking the medicine, the near-sight disturbance suddenly developed. He visited our hospital 2 weeks after taking the medicine.
Best-corrected visual acuity was 1.0 in both eyes. The anterior segment and posterior segment revealed negative findings. The alternate cover test showed 16 prism diopter exotropia in far and near distance. The near point of accommodation (NPA) was 16 cm in the right eye and 19 cm in the left eye, and sluggish pupillary reflex was noted in both eyes. The near-sight disturbance was relieved by near glasses correction. He stopped taking lorazepam 7 days after the first visit, and the NPA was 14 cm in his right eye and 12 cm in his left eye at 15 days after cessation of lorazepam. He restarted sedative medication with diazepam 4 mg/day, instead of lorazepam. Two months after cessation of lorazepam, NPA was recovered (6 cm in both eyes) and pupillary reflex was normal.