On the tests for muscular asthenopia and on insufficiency of the external recti muscles / Henry D. Noyes.

  • Noyes, Henry D. (Henry Drury), 1832?-1900
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: On the tests for muscular asthenopia and on insufficiency of the external recti muscles / Henry D. Noyes. 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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    In Febr. 1883, viz, after 2V2 months longer the condition was at 20' add. = 25°) 0 at 14 v. d. = 50 div. abd. = 5°j 30 v. d. = =2= Is was now noted that when his eyes turned to the extreme outer canthi he had homonymous diplopia i. e., in these positions the externi showed great weakness. He kept up the gymnastic prisms and after 7 months longer the condition was at 20' add. — 320) „0 at 12 v. d. = 30 div. abd. = 6°| 30 v. d. = 40 div. After another period of 6 months, viz in May 1884, he was able to use his eyes an hour at a time 3 times daily. Has no more headache. The condition was at 20' add. = 400) at 12 add. = 550) abd. = 6oj 40 abd. = i6oj71 v. d. = 30 div. v. d. = 30 div. Up to this time there had been an improvement, and the case seemed to be one of weakness of all muscles but chiefly, as I thought, and as seemed obvious, of the intemi. But on going over the history the one persistent fact was the feeble abduction both for far and near. The ad- duction had notably improved in both regions, but the abduction did not advance. Moreover the equilibrium test indicated feeble adduction both for far and near. I now determined to give credence to the figures of abduction as being the significant symptom. The result proved that their witness was far more worthy of acceptance than that furnished by the equilibrium test. I ordered prisms 20 base out ward for constant wear. These were used for 4 weeks and the figures became as follows, 1. = 400) . n at 12 add. = 600) , l. = 3V2o] 43V20 abd.= i5oJ 75( at 200 add. = abd. v. d. = 10 div. v. d. = 20 div. 60 at 12 + 36s add. = 400 abd. = 200 v. d. = 50 div 0 Has had great comfort in wearing adductive prisms; he uses them both for near and for distance. He is entirely certain that by them he gets much benefit. He was ordered to add to them + 36s m reading as the figures show that with them he has a better balance of muscles than without them. He reads no longer at 9 but at 14. This case completely convinced me of the fallacious character of the equilibrium test. The results which it indicated were in one sense facts, but these facts in my judgement were not primary but secondary. The divergence for distance as well as for near did not mean that the original trouble belonged to the interni, but that the interni came to be at fault through exhaustion and the original error belonged to the externi. I succeeded in improving the power of the interni and the patient steadily improved, but