The squint angle is that angle, which the visual line of the squinting
eye encloses with the direction it ought normally to take--it may be
measured with the aid of a perimeter. The patient's head is so placed by
means of a chin rest, that the axis of the squinting eye is in the
centre of the arc of the perimeter; a distant point in the centre of the
field of vision is fixed. Behind the patient is a candle, the reflection
of which is thrown into the squinting eye by means of a plane mirror;
now slide the mirror along the arc of the perimeter, till the reflection
on the cornea stands in the centre of the pupil of the eye which is
under observation. The point which the mirror occupies on the arc of the
perimeter, indicates the squint angle. In deviation in height of the
squinting eye, bring the arc of the perimeter into the corresponding
direction and so measure at the same time the degree of deviation in
height. Were the method more exact than it is, one would be able to
measure the angle formed by the visual line and the axis of the cornea.
To find the linear measure of the deviation, cover the fixing eye and
allow the squinting eye to fix. Hold a millimetre measure close to the
under lid, so that a chosen portion of it stands under the centre of the
pupil; uncover the other eye and when the squinting eye returns to its
deviation, it can be seen over which point the centre of the pupil
stands, and the linear measure of the deviation is thus obtained. The
secondary deviation of the other eye is measured of course in the same
way. If, in consequence of amblyopia, the squinting eye possesses no
certain fixation, the measure may be so held that the _nil_ point of the
division coincides with the lower punctum, and then in unchanged
fixation the portion lying under the centre of the pupil is determined,
first in the sound and then in the squinting eye.
The execution of one or other of these forms of measurement is in every
case to be recommended, and if their exactness is not as perfect as can
be desired, still, on the other hand it should be remembered, that for
surgical treatment, an exact measurement of the deviation does not
possess the importance sometimes assigned to it, as in most cases the
squint angle shows considerable variations.
In a large number of cases these variations are so great, that a correct
position of the eyes alternates with a more or less considerable squint,
which as the case may be, appears seldom or often, sometimes only under
certain conditions, and sometimes quite unexpectedly (periodic squint).
In some cases stationary or permanent squint begins with the periodic
form, however, one must not conclude that periodic squint is invariably
the precursor of the permanent form. In by far the greater number of
cases periodic squint continues unchanged without ever becoming
permanent.
Public-domain text, read in full here on John Shaqi.
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