CASE 13.--Auguste T--, æt. 28. On the left emmetropia, V. 12/20. On the
right the visual acuteness is variously given, but certainly does not
amount to more than 1/5 nor less than 1/10 of the normal.
Ophthalmoscopic report normal. The left eye is naturally the fixing one,
the right always remains parallel--for near objects double images are
present. A convergent movement is not attained, either for near objects,
or by means of prisms with bases outwards for distant ones. Prisms with
the bases inwards are not overcome; with vertically deviating prisms the
double images of distant objects stand perpendicularly above one
another.
CASE 14.--Ludwig v. K--, æt 32, has complained of diplopia repeatedly
for fifteen years. Statement in August, 1877: Convergence to a pencil
held before patient on the median line is only retained to about 50 cm.,
nearer, crossed diplopia occurs. In reading, binocular fixation is
possible with an effort at a nearer point. The facultative divergence
does not amount to more than 3°; even by convergence to a distance of 4
mtr. prisms of 3° only are overcome. Emmetropia and full visual acuity
on both sides. In Sept., 1880, three years after, the statement remained
unaltered. Patient has only used the prismatic spectacles then
prescribed off and on, as the symptoms are sometimes more troublesome,
sometimes less so, and he exerts his eyes but little on the whole.
A restriction of movement of the internal recti did not exist in these
cases; the absence of the convergent movement is not then to be set down
to the interni not possessing the proper power for acting, but only to
the fact that the impulse for their simultaneous innervation was
wanting. We frequently find this absence of innervation in divergent
squint, and then generally consider it to be a consequence of the
squint, which, however, as the above cases show, need not necessarily be
the case. If preponderance of the externi is at the same time present,
absolute divergence is the result, but not always permanent squint,
frequently only the periodic form. The anomaly of innervation may also
usually be proved in such cases, in that after the removal by operation
of the absolute divergence it continues to exist in the relative form;
it can indeed happen that for a few days after the operation convergent
squint is present for distance, together with relative divergence for
near objects.
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