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89
"Squint. A problem rivalling that presented by myopia
faces us in cases of squint. A careful analysis of eighty-one cases
which are now under treatment in the Borough has been made
and strikingly illustrates the important features of the condition.
"Squint may be caused by injury, by paralysis of the muscles
of the eye, or, most commonly, by the combined action of predisposing
weakness of these muscles and an error of refraction.
Whatever the cause, the net result is that when the patient looks
at an object, one eye is fixed on the object while the other looks
elsewhere. In short, one eye is being used and the other is not.
"It is an axiom of physiology that an organ which is not
being used loses its power. The eye is no exception. A squinting
eye is a workless eye and a workless eye will, in time, become a
blind eye.
"As will be seen from the table, 76 of the 81 cases had a
convergent squint and 5 an alternating one. Eighty of the 81
had errors of refraction and it is worthy of note that in the remaining
case the squint was only occasional. Hypermetropia and hypermetropic
astigmatism were found in 73 of the cases, a fact to be
expected, since these are the commonest errors of refraction in
young children. They were, however, rather more frequent than
they would be in a random selection of children, so that hypermetropic
defects seem to predispose more strongly to squint than
do other forms of refractive error.
"As a general rule, the refractive error of the squinting eye
appears to be approximately the same as that of the fixing eye.
In the cases under consideration 56 had almost the same refraction
in both eyes, while 25 differed to various extents. If, however,
we take only children over 5 years of age, the proportion definitely
alters, becoming 34 with no difference to 22 with some difference,
while in those under that age the figures are 22 and 3 respectively,
thus suggesting that as a squint progresses the refractions of the
two eyes change at different rates.
"The final group of columns in the table indicates the incidence
of amblyopia or blindness in the squinting eye. ' Moderate amblyopia'
was the name given to the group of cases in which the
worse eye read one or two fewer lines on the standard test card
than the better (i.e., R. eye 6/6 L. eye 6/9, R. eye 6/9 L. eye 6/12, or R. eye 6/9