On the etiology and treatment of convergent squint.

  • Snell, Simeon, 1851-1909.
Date:
[1887]
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Licence: Public Domain Mark

Credit: On the etiology and treatment of convergent squint. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    trial. Or the good eye may be covered, and the amblyopic practised with a magnifying glass, or in other ways, that readily suggest them- selves. In all cases of strabismus the refraction of each eye should be tested, and the error, hypermetropic or astigmatic, be suitably corrected. Wecker has recommended advancement of Tenon's capsule, combined with tenotomy, and Knapp has given his approval to the operation ; Abadie also prefers it to advancement of the muscle, as its effects can be more easily increased or decreased in a few days. Advance- ment of the external recti has also been prartised, instead of division of the internal recti. Of these procedures I have no personal expe- rience, and the same remark applies to Seherk'a recommendation of abscission of a piece of tendon in high degrees of strabismus. Orthoptic exercises with prisms and the stereoscope have from time to time been recommended. The following suggestion is made for what it is worth. Professor J. Michel, in Zehender's Klinische Monatsblatter for No- vember, 1877, p. 373, suggested the use of passive motion in cases of palsy of the ocular muscles by seizing the conjunctiva over them, and moving as far as possible the eyeball in the line of action of that muscle. There were difficulties, owing to the discomfort occasioned, in its performance. Recently, however, Spalding (Knapp's Archives, 1886, p. 492) and Alt {American Journal of Ophthalmology, April, 1887) have revived the proceeding with the aid of cucaine. Quite recently it occurred to me that such a plan would have some uses in the treatment of convergent squint. By dragging the eyeball out- wards in the line of action of the external rectus, it might increase the effect of this muscle; and, moreover, by putting the internal rectus fully on the stretch, might oveicome any tonic contraction of that muscle. These were the ideas that suggested themselves at the outset to me. I have only adopted the plan in two cases, once with distinct benefit ; the other is too recent to decide ; both were cases of extreme convergence. My experience is far too limited to offer any opinion as to whether the suggestion thrown out will be of value or not. It ap- pears that atropine and spectacles must be made use of also ; and I thick it is possible that the plan I have suggested may increase the number of cases curable without operative means, and leaving the physiological conditious intact. The proceeding is very simple ; cu- caine is instilled, and the eyelids separated with a speculum. The con- junctiva over the insertion of the external rectus is seized with forceps, broj,d ribbed, and the eyeball rotated outwards and backwards, so as to put the internal rectus on the stretch. The irritation resulting is not sufficient to prevent a repetition ol the proceeding the next day, or day after, as may be desired.