What has here prevented the transition to permanent squint with a
deviation corresponding to the great strain on the accommodation? That
the accommodation was really in action is proved simply by the apparent
emmetropia and the school-work, that no retention of binocular single
vision took place is shown by the proved incapacity for binocular fusion
of the retinal images. Nothing then remains but to accept the fact that
in the ocular muscles inducement was only given for a slight periodic
squint, not for a permanent one answering to the amount of accommodation
used.
As further proof that periodic squint may occur even in hypermetropia
quite independently of the accommodation, I should like to cite a case
of intermittent convergent strabismus which a number of other oculists
have seen besides myself.
CASE 5. Sophie S--, æt. 7-3/4, has suffered for two years from a strong
convergent squint on the left side, occurring every other day. The
deviation amounts to 7 mm. (the same deviation is transferred to the
left eye, when the right is put into fixation). On the intervening days
the position of the eyes is quite normal, on covering one only a slight
deviation takes place. The visual acuteness amounts to 5/12 on the left,
5/24 on the right, ophthalmoscopically with atropine hypermetropia of
two dioptres. Quinine has been given without avail, a convex glass of 2
D. also, which has been worn for the last half year, has not affected
the deviation.
Diplopia was not present--on the intervening days free from squint, with
the aid of a red glass, homonymous diplopia could be detected without
perceptible deviation, still it was impossible to bring about a union of
the double images by prisms. In the stereoscope the left field of vision
was first inspected, then both, still fusion of the fields of vision was
not traceable. The statements, moreover, as indeed could not be expected
otherwise in a child of such tender age, were not free from
contradictions, but the existence of normal binocular vision was very
doubtful. I therefore performed tenotomy of the left internal rectus,
after which normal position continued to exist on the following squint
days. After three quarters of a year I saw the child again; the squint
was perfectly cured, even on looking down, convergence was no longer
present. Whether a permanent cure was thus obtained, seems to me
doubtful, owing to the rare peculiarities of this case.
Public-domain text, read in full here on John Shaqi.
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