I've had multiple cycloplegic refractions, and aside from this one I've
never had a script anywhere near +3.50. I may gain 0.50D or so when
cyclopleged, but not 2-3D.

It makes intuitive sense that accommodative spasm _should_ decrease, but
most eye doctors can remember patients who couldn't accept full plus.

Accommodation and convergence are locked together and spasm of accommodation
affects convergence too.

Most likely the "failure to accept" means that relieving accommodation makes
the eyes struggle to stabilize at a new convergence posture. Usually it
works, but sometimes it doesn't.

-MT

Hi.  Ol' Johnny One-Note here again:

I think you could get pretty thorough cycloplegia with either a couple
of drops of Cyclogyl -- maybe 15 minutes apart, or with Homatropine
(maybe a touch less effective), or -- if you want to remove all doubt,
and can live with 10d - 2wks of symptoms -- four days of Atropine.

The last is the gold standard of "total cycloplegia."

If what you have is accommodative spasm, or accommodative infacility,
or ciliary spasm, or--more generally--accommodative dysfunction, then
you will likely want to have the doctor push the most plus power on
you that you can accept, both in a distance Rx and in a near Rx
(whether using bifocals or separate reading glasses), watching your
eye alignment carefully to check for any esodeviation that might need
to be managed through adjustments to the powers or through addition of
prism.

In some cases, you've developed enough "hypertonicity" in your ciliary
muscles that it's difficult for you to accept much additional plus. In
MY experience, I used cycloplegic drops every night (lower-strength;
effects gone by morning) for months, eventually "breaking the cycle."

But ... NOTE WELL: virtually all cycloplegic drops use a preservative
called Benzalkonium Chloride that has known cytotoxic effects to
corneas.  They should not be used long-term, *especially* if you have
any pre-existing ocular surface issues OR dry eyes.

It *IS* possible to get your "cramped," or "spasmed" eyes to learn to
"relax," with time.  

Another thing that I do is what's called "periocular warming" to help
relieve small amounts of accommodative spasm.  

Make/buy yourself a corn/rice bag ... like so:

http://www.quilt.com/MiscQuilting/RiceBags.html

Warm it in the microwave (I use about 2min on high) until it's warm
(NOT hot).  Place it over your closed eyes for about 10 minutes a
couple times a day.

It works.  No voodoo.  Actual science.  Here:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1
5885788&dopt=Abstract

OR http://tinyurl.com/obpyd

Best of luck!

Neil