CASE 1. Miss B--, æt. 22, possesses in both eyes myopia of 6·5 D. with
full visual acuteness and without posterior staphyloma. A concave
eyeglass of 4·5 D. is used off and on for distance, and the eyes have
never been over-exerted in looking at near objects. For a long time
tendency to convergent squint, which is combined with diplopia, has
existed on the left side. The eyes generally have a perfectly normal
position, but occasionally convergent squint occurs, remains in
existence a few hours, perhaps for a whole day even, and disappears
again. The deviation here amounts to 4 or 5 mm. As the patient did not
wish for an operation, I have been able to observe the condition for
years without any change in it or without the squint becoming permanent.
The cause of periodic squint is certainly not to be sought for here, in
the accommodation.
Many cases of convergent strabismus with myopia constantly offer such a
peculiar phase of the defect, that one has accepted the statements which
ascribe to short-sightedness a determining influence on this form of
squint, without asking for further proof. It may, therefore, be useful
for our purpose to cite a few cases of periodic convergent strabismus
with emmetropia. For instance:
CASE 2. Louise S--, æt. 6-1/2, came under treatment for follicular
conjunctivitis, convergent strabismus appearing simultaneously on the
right side; the investigation showed the acuity of vision of left eye =
5/12, right V. = 5/36, the ophthalmoscope, and also mydriasis by
atropine, proved the presence of emmetropia. The squint had first been
observed when the child was about two years old, then it disappeared
spontaneously and returned again three or four months ago.
In the course of treatment, which extended over about six months, the
child came repeatedly into my consulting room, sometimes with squint,
sometimes without, in the periods during which correct fixation existed,
no squint occurred even when working. Examination with the stereoscope
showed no normal binocular fusion even during normal position of the
eyes.
CASE 3. Vera von K--, æt. 6; tendency to convergent strabismus, mostly
on right side, has existed one and a half years. Normal position as a
rule, on covering the eye immediate convergence, with a deviation of 5
mm.; with additional aid of a red glass and weak prisms deviating in a
vertical direction, homonymous diplopia is very easily provoked. Visual
acuteness on both sides 5/12, the left slightly better than the right;
emmetropia in mydriasis by atropine. A year later a repeated examination
gave the same result.
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