CASE 43.--Julie B--, æt. 21, is stated to have squinted inwards since her third year, principally with the right eye, but with occasional alternation. The deviation amounts to 5 mm., the outward movement of both eyes is perfectly normal. Hypermetropia 2 D., visual acuteness 5/18 on both sides. Ophthalmoscopically with atropine the same degree of hypermetropia. Tenotomy of both interni on March 7th, 1879. On March 14th, deviation 5 mm., just as before. Then renewed division of the internal rectus and shortening of the external rectus of the right eye; but still the result was insufficient. Therefore, on March 21st, the left eye was dealt with in the same way. By this means a normal position of the eye was obtained, which was perfectly preserved when I saw the patient again a year and a half later. Everything led me to suppose beforehand that simple tenotomy of both internal recti would perfectly suffice to remove the squint, yet it was of no use, but had to be supplemented by shortening both external recti. In such cases I would not advise repeated tenotomies, but for the correction of the insufficient result as soon as possible by advancement of the antagonist. Advancement very frequently gives us an opportunity of seeing with our own eyes the insufficiency of the antagonist and its faulty anatomical development. We may suppose this to be the case if the mobility towards the side of the antagonist is faulty, however that is no proof; considerable insufficiency may co-exist with perfectly normal mobility. If limitation of movement is present, to which insufficiency of the antagonist may be assigned as the cause, or if it is desirable to obtain the greatest possible result by means of an operation on the squinting eye, we must combine tenotomy of the deviating muscle with advancement of the antagonist. The same is stretched tighter, and rolls the eye more strongly to its side, and we can regulate the degree of shortening of the muscle, by the distance behind the insertion at which we place the threads in the muscle, also by the distance from the corneal margin at which we place our anterior sutures, although the rapidly increasing ductility of the conjunctiva makes it desirable that we should not go far from the corneal margin.