Practical remarks on strabismus : with some novel suggestions respecting the operation / by G. Critchett.

  • Critchett, G. (George), 1817-1882.
Date:
1855
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Licence: Public Domain Mark

Credit: Practical remarks on strabismus : with some novel suggestions respecting the operation / by G. Critchett. 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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    Before I conclude this paper, I would just briefly glance at two or three points of some practical interest,, haring reference to the age of the patient, and condition of the eye at which the operation should be performed, and to the effect of the operation upon vision. As regards the first point, my own experience, derived from many hundred cases, is, that the most favourable results occur in young adults, as contrasted with children. Cases in which the relative position of the eyes is not uniform, and is aggravated and altered by mental or bodily excitement, and in which there is any oscillatory or rotatory movements, are all uncertain in their results, and very liable to he followed by undue prominence of the globe, or by eversion, or both. On this account, I do not find operations on children succeed so well as on young adults. As regards the effect of the extent of the distortion in influencing the result of the operation, it is difficult to lay down rules. As far as my own experience goes, I should say that in most extreme cases of inversion there is only a partial improvement from dividing one muscle, and it is a nice point to determine if there be sufficient distortion remaining to make it safe to divide the inner rectus of the other eye, without risking eversion. Unless the eye occupy a position at least midway between the inner caruncle and the central axis, it is not safe to operate. The chief causes of eversion, after the operation, are to be traced to the previous slight degree of the inversion, to the unsettled state of the disease, or to an undue division and separation of parts; and if the slightest eversion occur at the time of the operation, there seems to be a constant tendency to increase, until it has reached its extreme limits. This arises from the disadvantage at which union takes place, the power of the external rectus muscle, and the loss of the rectifying and controlling power of vision. Eversion sometimes occurs weeks and months after the operation, in consequence of the gradual stretching of the uniting medium, an analogue of which is to be found sometimes after fracture of the patella, in which very extensive separation of the two portions occurs. The very worst cases of eversion that I have ever seen have resulted from a simultaneous division of the muscles of both eyes, a proceeding that is in no case justifiable. The effect of the operation upon vision is surrounded with obscurity and difficulty. In the first place, much variety exists in the extent to which vision is impaired by strabismus; in the alternating form, both eyes are equally good; in children but little damage is done; but where the deformity has existed several years, there is almost invariably imperfect vision, differing, however, in degree in nearly every case. In several remarkable cases that have come under my notice in my own practice, in that of my friend, Mr. Dixon, and others, a very sudden and complete restoration of sight has followed the operation. I should hesitate to assert this curious and almost inexplicable phenomenon, had I not verified the fact over and over again in a manner that admits of no doubt. Mr. Holthouse has endeavoured to explain this by supposing that the muscles of the eyeball focus the eye, mid that the operation restores this power. If this were tho true solution of the riddlo we should find