Headache and ocular treatment / by Freeland Fergus.

  • Fergus, A. Freeland (Andrew Freeland), 1858-1932
Date:
1908
Catalogue details

Licence: In copyright

Credit: Headache and ocular treatment / by Freeland Fergus. Source: Wellcome Collection.

    14/20 page 14
    5| metric angles at least, or even more for comfort. His near point of binocular fixation would thus require to be approxi¬ mately 46°- inches, nearly 7. Unless he has that amount he has discomfort. Take the case of a man who requires to work as close as 10 inches. That man would require to have his near point of binocular fixation at a not greater distance from his eyes than 6 inches. So far as I am aware, the best instrument for testing this binocular point of convergence is Landolt’s ophthalmo-dynamometer. There are other methods of measuring which I sometimes employ, but that is the one which I always teach junior students to use, and which I find to be about the best in practice. Now, there is no doubt whatever in my mind that defects in this range of convergence are a frequent source of ophthal¬ mic headache. The patient quoted above, No. 10, was an instance in point, and I could lay my hands just now on notes of about a dozen of cases where relief of persistent and long continued headache had been secured by the proper treatment of a defect in convergence. There are at least three distinct methods of remedying such defects. The first is, as noted above, the decentration of the spectacles which the patient wears. That, of course, involves that he has such an error of refraction as requires correction. The second is the wearing of prisms with the apices out, and where the error is not greater than can be overcome by a prism of 1J or even 2 degrees of minimum deviation before each eye, I think that to be quite a legitimate mode of treatment, if the person wear the glasses absolutely constantly. The third method, the one which in the main I prefer, is the advancement of one or other of the internal recti; the particular muscle to be advanced being determined by the investigation of the fields of fixation. I never resort to operation immediately after seeing a case of this kind, for I am aware that sometimes, by proper tonic and hygienic treatment, the condition may improve, and render operative treatment unnecessary. Still, I often find cases where operation is refused, and in which the patient continues to suffer notwithstanding all the treatment employed. About a year ago I had such a patient, jointly with Dr. M'Clure, a girl who had suffered considerably from headaches, and who had run the whole gauntlet of treatment for their relief. She was made absolutely well, by the simple operation of advancement of an internal rectus muscle, an operation which is perfectly easy, and for the most part perfectly safe. These observations must suffice for the consideration of exophorias.
    digitised image 1
    digitised image 2
    digitised image 3