On the operative treatment of strabismus / by Freeland Fergus.

  • Fergus, A. Freeland (Andrew Freeland), 1858-1932.
Date:
1900
Catalogue details

Licence: In copyright

Credit: On the operative treatment of strabismus / by Freeland Fergus. Source: Wellcome Collection.

    19/34 (page 13)
    convergence is deficient. In the particular case here referred to it unquestionably was, and that probably owing to the tenotomy, which, however much it had impaired one internal rectus, had not even apparently removed the squint nor strengthened in any way the external muscles. In future, when examination of the field of fixation shows marked defective power in the internal recti, I shall not advance both muscles at the same time. This is the only case in which there has been even the slightest divergence. But what of that ? It does not matter; this slight divergence is due to the destroyed convergence, and all that is required to put it right is an advancement of the previously divided internal rectus. Speaking generally, however, I find it to be the rule that the operation should be performed on both external recti when the strabismus is severe, and when the internal recti are nearly of normal strength. The advantages, then, which may be claimed for the oper¬ ation are—(a) It does not, except from the carelessness of the operator, lead to divergence, and if it should, then the defect is easily remedied by advancement of the internal rectus; (b) it does not in the least interfere with the function of the internal recti, so that if their power was good before, it remains good and the patient may have an excellent range of convergence. 2. In the next place, the operation is easily performed. So far as that goes, a few drops of a solution of cocaine intro¬ duced into the capsule of Tenon render it all but painless, so that only for young children or for timid and nervous persons is a general anaesthetic required. The pain is reduced to a minimum if the patient during the operation is made to look in such a way as to relax thoroughly the muscle which is being operated on. Thus, if the right internal rectus is being attached, the patient should be made to look to the right side. This is an important point. That the operation is simplicity itself is proved by the fact that an internal or external rectus muscle can with the utmost ease be advanced within a period of ten minutes. I do not