Heterophorias And Insufficiencies a Clinical Study

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Whether the oft- mentioned spasm of convergence occurs without excess of the interni, or insufficiency of the externi, except in general disease, as meningitis, hysteria, or chorea, or from local conditions, as from hyper- metropia, hyperphoria, or improper glasses, is some- what doubtful. There are rare cases which show good balance of the ocular muscles and normal divergence at times, which at others show esophoria and weak divergence. Probably these are mostly instances of latent esophoria b...ecoming manifest, like the other more numerous cases in which eso- phoria is increasediunder just such general conditions. It would be as rational to refer them to exhaustion of divergence as spasm of convergence, the excess of convergence being*simply a secondary result.
A Clinical Study. 69 In cases of esophoria and excess of convergence it is well to treat the deviation with caution, espe- cially when hypermetropia coexists, using atropine and attempting to relax the interni ; over-correction of hypermetropia, or convex glasses for reading in non-presbyopic cases, I do not particularly favor, although the latter plan may sometimes be followed with benefit.


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