The history of the scientific elucidation of ocular counterrolling

The history of the elucidation of ocular counterrolling (OCR) is an interesting one. Although discovered two centuries ago, OCR has remained a contro- versial issue, even in our days. The main reason for this, is that rolling move- ments of the eyes about the line of sight are not easily detected or measured. OCR can be static, i.e. about 5 degrees counterrolling of the eyes which partly compensates for tilting of the head with respect to gravity, or it can be dynamic, that is to say a rotatory optokinetic and vestibular nystagmus. The rolling movement of the eyes about the line of sight can be seen when tilting the head of another person towards one of his shoulders. Close inspec- tion of the conjunctival vessels reveals the jerking movements of the quick phase of the rotatory nystagmus. This is what John Hunter must have seen some two hundred years ago, as he described dynamic OCR in 'The use of the oblique muscles', in a book called 'Observations on certain parts of the animal oeconomy' (1786)

Increased muscle tension and reduced elasticity of affected muscles in recent-onset Graves' disease caused primarily by active muscle contraction

In 3 patients with Graves' disease of recent onset, length-tension diagrams were made during surgery for squint under eyedrop anesthesia. The affected muscles were found to be very stiff when the other eye looked straight ahead. It was expected that these stiff muscles would be able to shorten to some extent but would be unable to lengthen, due to fibrosis of the muscle. We found that the affected muscles did not shorten very much when the other eye looked into the field of action of the muscle. Unexpectedly however, they lengthenend considerably when the other eye looked out of the field of action of the muscle. This finding implies that the raised muscle tension and reduced elasticity of affected muscles in these cases of Graves' disease of recent onset were primarily caused by active muscle contraction, not by fibrosis

Keratomycosis caused by Acremonium Recifei, treated with keratoplasty, Miconazole and Ketoconazole

A patient is discussed who developed a fungal corneal ulcer due to Acremonium (Cephalosporium) Recifei after a piece of a coconut flew into his eye while he was cracking it. Treatment consisted of keratoplasty, Miconazole as ointment and intravenously, and Ketaconazole orally. Diagnosis and treatment of fungal corneal ulcers are discussed briefly

How Accurate is Orthoptic Examination at Age One?: The Early vs. Late Strabismus Surgery Study Group

The Early vs. Late Strabismus Surgery Study Group is a group of strabismologists and orthoptists who wish to investigate whether early or late surgery is better in cases of infantile strabismus, in a controlled, multicentre, matched-pair trial: All infants will receive a standardized entry examination at age one and then be operated either before their second birthday in clinics A, or between the 32nd and 60th month of age in clinics B. The children will be evaluated at age six. After completion of the study, one child will be selected from each group, to form a pair of children with the same entry examination, who were operated early or late. Successive pairs will be generated so that finally two smaller groups with the same entry examinations are formed. These two groups can then be compared regarding degree of binocular vision, angle of squint and visual acuity of the worse eye. It was decided to perform first a pilot-study of the examination of infants age nine to 15 months, because we wanted to know to what degree of accuracy infants age one can be examined and what parts of the examination can be carried out most reliably and can therefore be used as parameters to match the pairs in the main study. 190 Children were each examined by three examiners on one day, according to a standardized examination sheet, and differences were quantified. We found that the angle of squint could be measured with reasonable precision: The largest difference between any two of the three measured angles averaged at 6.5″. The angle did not increase when the infant was examined a second or third time. Variability of the angle, vertical divergence and up-/downshoot-in-adduction could not be assessed reliably. On the other hand, restriction of abduction (in a 4-class scale) could be measured with adequate precision: in 58% there were no differences at all between the three examinations. The degree of amblyopia could be well assessed by observing the fixation pattern by means of direct fundoscopy with a fixation mark or by comparing corneal reflexes during monocular fixation. Using a 3-class scale, there were no differences at all between the three examinations of the three orthoptists in 94% of the cases. In addition, amblyopia could be accurately assessed by observing the fixation behaviour of the child with either eye, in a 5-class scale

Inappropriate prescription of prism glasses for obligate fixation disparity measured with the Pola test

In the subjective measurement of fixation disparity (FD), the subject sees and fuses contours presented in the peripheral macular areas of both eyes ('fusion loek', a square for instanee). The pointing direction of the foveolae of both eyes relative to each other is determined by means of two haploscopically seen objects presented in the central visual field (Fig. la). ..

The Protocol for the Early vs. Late Infantile Strabismus Surgery Study

Abstract. The Early vs. Late Infantile Strabismus SurgerY Study Group is a group of strabismologists and orthoptists who investigate whether early or late surgery is preferable in infantile strabismus, in a non-randomized, prospective, multi-centre trial. Infants between 6 and 18 months of age will receive a standardized entry examination and then be operated either before their see"Ond anniversary in clinics A, or between their 32nd and 60th month of age in clinics B. The children will be evaluated at age six. After completion of the study, the two groups can then be compared regarding degree of binocular vision, angle of strabismus and visual acuity of the worse eye relative to the better

Robinson's computerized model of eye muscle mechanics revised.

The computerized model of static eye-muscle mechanics developed by Robinson was revised extensively and improved. An extensive literature study yielded additional information on the average diameter of the eye as related to age, on the average location of the insertions and origins of the eye muscles, and on the average cross-sectional area and length of the eye muscles

Treatment of Partly Accommodative Esotropia With a High Accommodative Convergence-Accommodation Ratio

In the June 1987 issue of the Archives, the results were published of a study by Kushner et al1 on the treatment of accommodative convergence excess, with bilateral medial rectus recessions or recessions with 14-mm posterior fixation sutures. Posterior fixation surgery was considered an unsatisfactory technique in this study, a conclusion based mainly on the frequent occurrence of overcorrections, although large undercorrections also occurred in the recession with posterior fixation suture group. Mims,2 in a letter to the editor in the September 1987 issue of the Archives, reached a similar conclusion: six overcorrections in a group of 30 patients.We think that at least some of these overcorrections were caused by adding a large, uniform-dose posterior fixation operation to a recession that, by itself, was appropriate for the angle measured at distance fixation

The Early vs. Late Infantile Strabismus Surgery Study: Monitoring Report

Abstract: The Early vs. Late Infantile Strabismus Surgery Study Group is a group of strabismologists and orthoptists who investigate whether early or late surgery is preferable in infantile strabismus, in a non-randomized, prospective, multi-center trial. Infants between six and 18 months of age will receive a standardized entry examination and then be operated either before their second anniversary, in clinics A, or between 32nd and 60th month of age in clinics B. The children will be evaluated at age six. After completion of the study, the two groups can then be compared regarding degree of binocular vision, angle of strabismus and visual acuity of the worse eye relative to the better one. This is the second monitoring report of the study