A clinical lecture / by Cornelius R. Agnew.

  • Cornelius Rea Agnew
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: A clinical lecture / by Cornelius R. Agnew. Source: Wellcome Collection.

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    the print is blurred. Thus we see that he has no power of accommodation, that his ciliary muscle does not act. We find, then, that there are seven muscles deficient in power : i. The muscle which raises the lid, the levator palpebrae superioris ; 2. The muscle that turns the eye inward, the internal rectus muscle ; 3. and 4. The muscles that turn the eye upward, the superior rectus and inferior oblique ; 5. The muscle that turns the eye downwards, the inferior rectus ; 6. The muscle which contracts the pupil, the sphincter iridis ; 7. The muscle that controls the shape of the crystalline lens, the ciliary muscle. These seven muscles are affected, and that fact indicates to us that the third nerve is involved in what seems to be paralysis. The next step is to ascertain the state of vision in the left eye. Tested by Snellen’s test-types we find Right Eye, Vision = f-jj-, and Left, Vision = The next thing to be ascertained is whether or not the vision of the left eye can be brought up to the normal standard by means of glasses. We first try a weak convex glass, -f- 7^, before the left eye, and he says that it confuses the vision. We next try a -j- -§V, and he says that he sees still less distinctly. We now try a weak concave glass, and he says that it makes his vision worse than either of the other glasses. The affected, eye then, seems to be emmetropic. We will next try a weak convex glass over the right eye, and he says he is not able to read the lower line. He has, therefore, no manifest hypermetropia. It is unnecessary to try this eye with concave glasses, for we know it is not myopic because with it he reads that is, he is able with this eye to bring parallel rays to a focus upon his retina. The presumption is, then, that both eyes are emmetropic, but an examination with the ophthalmoscope may reveal some latent hypermetropia. The next step in our investigation of the case is, there¬ fore, to make an ophthalmoscopic examination, and see whether, in connection with this paralysis of the third nerve, there is any deeper lesion. I think you will find, in almost all of these cases of paralysis of the levator muscle of the lid, in which the
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