Contribution to the correction of strabismus by the advancement of the rectus / by A.E. Prince.

  • Prince, A. E. (Arthur E.)
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Contribution to the correction of strabismus by the advancement of the rectus / by A.E. Prince. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    perfect, the latter E. e. being advanced by a second operation. ■Theoreticallj^ both k. e. should have been advanced at the first operation, but the necessity for the second operation is but testi- mony in favor of the rule—which, had it been followed would have led to a perfect o^Deration the first time. IS'o. 1370. Madame D -, eet. 42. When a child had both _R. I. divided for internal S. In place of the tendon, the muscle was divided outside of the Capsule of Tenon, and both retracted in the orbit. The external recti operating without any counter- force, an extreme external deviation was the result, amounting to 60° (35° in one eye and 25° in case of the other). It was deemed advisable to attempt an operation, thoygh without much expectation of success. The external recti were accordingly -divided, and to inei-ease the liberty toward internal motion, the capsule was split meridionally above and below the muscles which •were found to be exceedingly strong. 'No attachments were found internally, and no muscular fibers. Nothing except the most :atrophied conjunctiva. Into this the double-loop suture was placed and the knot tightened to its limit. The temporary result was admirable. For a week there remained a slight internal strabismus which finally became converted into a slight deviation outward, (15°) for which a second operation was not considered advisable. This case taught the important lesson exemplified in i;he next case, viz., that when it is a case of total, paralysis, or •due to complete separation of the muscle from the eye, the oppo- ■site muscle should be divided entirely outside of the Capsule of Tenon, that it may be free to retract in the orbit, and exert no more influence on the eye than its paralyzed opponent. When «uch eye is straightened, we can of course expect only a limited amount of motion. No. 1546. Mrs B , colored, ajt. 26, congenital paralysis of -3rd pair, implying loss of power over the superior, inferior and internal rectus, the inferior oblique and levator palpebree supe- rioris, which last was but partially aflFected. The result of this is an external deviation of each eye of 50°, making a combined external strabismus of 100° with immobility of the eyes. But a small portion of the pupil could be seew in the extreme ■external canthus of each eye, and when vision was attempted the head was held to the right or left, according ta which oye was employed in vision, this being with each eye.