Strictly speaking, the periodic squint present in these cases is of a
peculiar kind, for the binocular single vision present within range of
the convergence excludes the notion of squint; the latter only occurs
when an object lying outside the point of convergence is fixed.
Moreover, according to the common use of language, I have only used the
expression periodic convergent squint for the change between a parallel
direction of the visual axes and pathological convergence.
As squint in myopia usually commences at an age when binocular fusion
has already become a fixed habit, diplopia regularly takes place with
it, but patients become more easily accustomed to this than in paralysis
of the ocular muscles, because the retinal images are indistinct and the
double images in the field of vision always keep at about the same
distance, while in paralysis of the ocular muscles the distance is
constantly changing.
The myopia, in these cases, is not the cause of the squint, but only a
favouring circumstance. If the same preponderance of the interni is
developed at the same age in emmetropia, squint is not so easily caused,
as the distinct retinal images present in the whole field of vision
render it easy to retain binocular single vision. Therefore we see the
same form of squint arise less often in emmetropia (see Case 45) when
childhood is past, than in myopia. As a rule preponderance of the
interni in hypermetropia leads eventually to convergent squint even in
childhood.
In emmetropia and hypermetropia convergent strabismus seldom arises
after the tenth year (paresis of the abducens of course excepted),
therefore in my investigations as to the time of commencement of typical
squint I have only considered those patients who came under my treatment
before their tenth year. We must rely for the most part on the vague
statements of the parents, which lose in exactness in proportion as the
origin of the squint is of distant date; moreover, I have myself seen a
great many of the children before they were four years old. In this way
I have collected reliable information respecting the origin of the
squint in 193 cases, and of these (_a_) 88 cases occurred in children
one to three years old, (_b_) 53 in children three to four years old,
(_c_) 35 cases in children of over four years of age. It is thus at once
seen that in the great majority of cases, convergent strabismus
commences in children under four years of age, who have not yet begun to
read and write, and have no inducement to use their accommodation
severely, and still less continuously.
SQUINT FROM PARALYSIS OF THE ABDUCENS.
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