Muscular asthenopia and its treatment by graduated tenotomy / by Charles Hermon Thomas.

  • Thomas, Charles Hermon.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Muscular asthenopia and its treatment by graduated tenotomy / by Charles Hermon Thomas. Source: Wellcome Collection.

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

    9/12 (page 179)
    In my first paper on this subject, written six years ago/ I stated in effect that the fan-shaped expansions of the tendons of the recti at their insertion into the sclerotic are wider and thinner and their margins more elastic than is generally appreciated; and, that the elasticity of the margins is an influential factor in the production of a relaxation of tension in the tendon, graduated and definite in amount and perma- nent in character, permitting the effectual central portions of the tendon to retract and form a new attachment to the globe further back. This I desire at this time especially to reaffirm and to add that graduated tenotomy is practicable and effective, only because of the elasticity of the margins of the tendons. No attempt is here made to distinguish between the tendon and its immediate covering derived from Tenon's capsule; for distinct as they are anatomically, they are one surgically, for the purposes of this operation, at least, and are to be treated as one. It is true that occasionally a case is found in which no appreciable change in position occurs until complete severance has been accomplished, but such cases are altogether rare and exceptional. In the great majority of cases a gain graduated from 1° to 8° may be made without complete severance. In those exceptional cases referred to, the tendon is thick and narrow at its insertion, and the elastic margins are either deficient or absent. The technique of graduated tenotomy involves considerable difficulty and complication at times, and the performance of the operation is not to be looked upon as in any sense a trivial procedure. It is an altogether more delicate and difficult opera- tion than that for strabismus; and not less so indeed than any other operation done upon the eye-ball, not excepting that for cataract: but, when skillfully performed, it may be expected to yield definite and satisfactory results. It cannot be successfully undertaken without special instruments. Those devised by Dr. Stevens leave little to be desired. The ordinary strabis- ^Graduated Tenotomy in the Treatment of Insufficiencies of the Ocular Mus- cles, by C. H. Thomas, M. D. Trans. Philadelphia County Medical Society^ March, 1888.