If we undertake the task of converting the statements of patients as to
previous squint into observations, in order to confirm the statements
from the objective material, we must first prove whether the squint
cannot by some means be still produced (by excluding the eye or by
raising or lowering the eyes). Thus the condition of binocular vision
offers us valuable guides. If we find that binocular fusion does not
exist with available power of vision on both sides, but that the same
conditions of sight appear in the eyes as we have learnt to attribute to
squint, there is no reason for doubting the statements about a
previously existing squint. It is otherwise in those cases of extreme
amblyopia where normal binocular vision is never expected, or at least
cannot be proved on account of the enormous difference between the two
eyes.
If we discover the existence of normal binocular fusion, squint may
nevertheless have been present at a former time, for in many cases, of
periodic squint particularly, the habit of binocular fusion is never
quite lost.
That squint can disappear of itself is unquestionable; how often this
happens it is difficult to say. The fact that in ophthalmic practice we
see many more squinting children than adults is best explained by
this,--that squinting children are brought to us by their parents, while
adults who still squint have usually given up any desire for a cosmetic
improvement, and only come under treatment accidentally or on account of
other ailments; lastly, a considerable number of cases are cured by
operation. If the squint has disappeared we only discover by accident
that it was ever present. The fact of its previous existence may usually
be determined by other signs more positive than mere statements from
memory; with reference, however, to the age at which the spontaneous
cure takes place we are left to depend almost entirely on the patient's
statement. As far as I have been able to determine, the period from the
ninth or tenth up to the sixteenth year seems to offer the most
favorable conditions.
We rarely have an opportunity of watching the disappearance of squint,
still I have observed two cases in which a permanent convergent squint
disappeared after about a year. In both cases the squint had arisen in
young people (of eight and nineteen years of age) in the course of
irido-choroiditis which terminated in blindness, and disappeared with
the sight. The fixing eye was emmetropic in one case, in the other the
condition of error could not be determined owing to nebulæ of the
cornea.
We more frequently see periodic squint disappear.
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