CASE 42.--Marie S--, æt. 6, came under treatment on November 28th, 1878,
for recent superficial marginal keratitis of the left eye, which was
treated first with atropine; a few days later slight blepharitis
appeared also. On December 9th, atropine was discontinued; on the 14th,
the position of the eyes was still quite normal; on the 19th, permanent
convergent squint of the left eye was present. Squint had never been
observed in the child before. Double images were voluntarily announced
without my having inquired for them, they were homonymous and moved
further apart at both sides of the visual field. On December 28th, the
squint still remained the same, the double images were, however,
scarcely noticed by the child, so quickly do the relations of the
corresponding points of the retina change even in the sixth year. Both
eyes were atropinised for the better determination of the error, when a
slight degree of hypermetropia was shown by the ophthalmoscope, at most
1·5 D.; certainly a higher degree was specified when the vision was
tested, namely, on the right H. 2·5 D., V. = 5/12 to 5/9, on the left H.
1·75 D., V. = 5/18, probably, however, the objective determination was
more exact than the child's statements. If a child of six knows its
letters and figures sufficiently well to undergo a visual test, that is
as much as we can expect; in any case, however, the forms of the
letters and figures which we use for the visual test are not easy to
children, and the more objective the way in which the child comprehends
the examination, the less it perplexes itself by guesses, but only names
the letters which it really distinctly recognises, the less deficient
are the reports as to the visual acuteness; the proportionately larger
retinal images are still recognised, even if they are no longer quite
distinct, but consist of diffusion circles as a result of
over-correction of the hypermetropia. That these observations were right
for the case in point, is seen by the fact that eight days later, after
the effects of the atropine had passed off, the child could see better
with the naked eyes than with convex glasses, and that finally, when it
had become accustomed to the forms of the letters and figures employed,
V. = 5/9 was announced on the right, and V. = 5/12 on the left.
Mydriasis by atropine had no influence whatever on the squint,
therefore, on December 31st, convex spectacles 2 D. were prescribed for
permanent use. On January 4th, the linear deviation still amounted to 4
mm.; on January 15th, convergence was no longer discernible for
distance, with red glass double images occurred at once; on January
21st, no squint was present, and binocular fusion was again restored;
prisms immediately caused double images, the facultative divergence was
= 0. I thought it prudent to order the spectacles to be worn till the
middle of March, when they were discontinued; squint has not appeared
since then.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account