CASE 33.--M--, a boy æt. 10, was first examined by me in April, 1873;
the right eye has hypermetropia 4·5 D., and almost full visual
acuteness, the left has convergent squint, and recognises No. 6-1/2
(Snellen) with convex 10 D.; V. = 1/18 at 1 metre. (The boy's father
also squints with the left eye, which is amblyopic to a high degree (V.
= 1/36), right eye has emmetropia, and full visual acuteness). The
prescribed spectacles (convex, 4·5 D.) were used for working, but not
continually; still three years later, in 1877, the deviation was
considerably less and only occurred occasionally. In March, 1880,
nothing more was seen of the squint, only slight convergence still
recurred on excluding the left eye. Patient now wears convex 4·5 D.
constantly.
On account of the importance which the disappearance of squint possesses
in hypermetropia I will describe a few more cases which belong here.
CASE 34.--Mrs. B--, æt. 32, has on the left H. 1·5 D., V. 5/9; on the
right H. 1·5 D., V. 5/12, binocular vision (H. =·75 D., V. = 5/6 to
5/9). Asthenopic troubles are the cause of her present complaint. She
says she squinted with the right eye as a child till her eighth or ninth
year; the present position of the eyes is quite normal; ordinary type is
read at the usual distance with normal fixation without glasses.
Particularly keen fixation is rarely followed by squint, which may be
produced by excluding the right eye; the latter then deviates about 5
mm. inwards and slightly upwards; the secondary deviation of the left
eye is rather less. Only the left visual field is seen in the
stereoscope.
CASE 35.--Mrs. W--, æt. 31, has on the right H. 3·5 D., V. 5/9, on the
left V. = 1/16 with + 4 D., single words of No. 0·8 are read (mother and
aunt have also congenital weak sight in this eye). Position and movement
of the eyes are perfectly normal, exclusion of the left eye is followed
by slight relative divergence. In answer to my question whether she had
not previously squinted, patient replied that she did not know, it had
always been a matter of dispute in her family; as, however, only the
right visual field was seen in the stereoscope, we may be sure that
squint had been present and that binocular fusion had been lost in
consequence.
CASE 36.--Mrs. G--, æt. 49, report in March, 1876: On the right H. 3 D.,
V. 10/10, on the left H. 4 D., V. 10/40; a previously existing squint
had disappeared of itself; the position of the eyes appears perfectly
normal, but binocular fusion is not present; with red glass before one
eye and a prism deviating in a vertical direction before the other,
patient does not see double, but first with one eye and then with the
other. The squint as well as its disappearance occurred however, at a
time when it would have been regarded as an error to allow children to
use convex glasses.
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