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Dedication

The gods split these creatures into two parts, creating male and female

humans. The belief is that each one of us, on a deeply subconscious level,knows that something is missing within ourselves, and we seek wholeness.

Rephrased from Plato, The Symposium

For Dale

My missing half


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Fig 1-2The letters used in one of the letter-matching tests. The examiner shows the

child a letter on a flip card on the left. The child holds the card on the right and

matches the same letter by pointing.

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6240 62$ ,62$+=

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F+/,+ 6, 62$ 4(6&4) 3/)46/0: 3+,F= A2/' ,F6/,0 3,$' $)/./046$ .&(2 ,D 62$ K,++# ',.$ (2/)3+$0

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Fig 2-1On the left is a cutaway view of an eye and on the right is a camera.

Lines connect similar components.

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$)$(6+,0/( 3$6$(6,+= A2/' /' 62$ )/:26 '$0'/6/G$ .46$+/4) 6246 F+$'$+G$' 62$ /.4:$ 6246 K4'


21/112


D,(&'$3 ,0 /6= 5D6$+ 62$ F/(6&+$ /' 64M$0? #,& K/)) 0$$3 6, K4)M ,+ 3+/G$ 6, 62$ F2,6, F+,($''/0:

'6,+$ 6, 24G$ 62$ F/(6&+$ 3$G$),F$3 403 F+/06$3= 5)6$+046/G$)#? K/62 3/:/64) F2,6,:+4F2# #,&

(40 (,03&(6 62/' '64:$ ,0 #,&+ 2,.$ (,.F&6$+= ^/04))#? #,& K/)) 24G$ 62$ D/0/'2$3 F/(6&+$ ,D

#,&+ 34&:26$+ 6246 #,& (40 ),,M 46 K/62 F+/3$ 403 './)$=

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+$(,+3 4 '($0$= `I$$ 4:4/0 ^/:&+$ N\P D,+ 4 (,.F4+/',0 ,D 62$ F4+6' ,D 62$ $#$ 403 62$ F4+6' ,D 4

(4.$+4c= W0 62$ $#$? 62$+$ 4+$ 6K, '6+&(6&+$' 6246 4(6 )/M$ 62$ )$0' /0 4 (4.$+4= A2$ G$+# D+,06 ,D

62$ $#$ /' 4 ()$4+ '6+&(6&+$ `.&(2 )/M$ 62$ (+#'64) ,0 4 K46(2c (4))$3 62$ &*%-"$= W6 /' ,0$ ,D 62$

6K, Y)$0'$'Z ,D 62$ $#$j 2,K$G$+ /6 (400,6 (240:$ /6' D,(&'= 5 '$(,03 '6+&(6&+$ /0 62$ $#$?

(4))$3 Y62$ &%6#)$//0-" /"-#Z '/6' -$2/03 62$ F&F/)= A2$ &%6#)$//0-" /"-#/' 4-)$ 6, (240:$ /6' '24F$

-# .$40' ,D 62$ &0/0$%6 :8#&/"`4' 3$'(+/-$3 -$),Kc 403 62&' 4)6$+ 62$ D,(&' ,D )/:26 F4''/0:

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K/62,&6 ,&+ 62/0M/0: 4-,&6 /6= A2$ &*%-"$403 &%6#)$//0-"/"-#D,(&' )/:26 ,0 62$ )/:26 '$0'/6/G$

6/''&$ ,0 62$ /0'/3$ ,D 62$ $#$ k 62$ %")0-$k K2/(2 /' 3$'(+/-$3 -$),K= A2$ 0%0#k 62$ F4+6 62463$6$+./0$' ,&+ $#$ (,),+ `-)&$? -+,K0? $6(=c /' 4 3,&:20&6 '24F$3 '6+&(6&+$ -$6K$$0 62$

&*%-"$403 62$ &%6#)$//0-" /"-#= ;# (,06+4(6/0: ,+ +$)4R/0:? 62$ .&'()$' /0 62$ 0%0#(40 4)6$+ 62$

'/b$ ,D 62$ 2,)$ /0 /6' ./33)$ k 62$4840/= A2$4840//' 62$ -)4(M (/+()$ /0 62$ ($06$+ ,D 62$ 0%0#403

/' )/M$ 62$ 2,)$ /0 62$ 3,&:20&6 `62$ 0%0#c= A2$4840//' ,0)# -)4(M -$(4&'$ 62$+$ /' 0, )/:26 /0'/3$

62$ $#$= W6 /' (,.F4+4-)$ 6, 62$ ,F$0/0: /0 62$ ($06$+ ,D 62$ 3/4F2+4:. ,D 4 (4.$+4? 62+,&:2

K2/(2 )/:26 F4''$'= W0 34+M '/6&46/,0'? 62$4840/$0)4+:$' 6, )$6 .,+$ )/:26 F4'' 62+,&:2j /0

-+/:26$+ '$66/0:' /6 (,0'6+/(6' 6, )/./6 62$ 4.,&06 ,D )/:26 $06$+/0: 62$ $#$=

B/62/0 62$ $#$? '&++,&03/0: 62$ &%6#)$//0-" /"-#/' 4 +/0: ,D .&'()$ (4))$3 62$ &0/0$%6 :8#&/"= W6

/' 4664(2$3 6, 62$ (+#'64))/0$ )$0' -# 6/0# 62+$43' (4))$3 @*-8/"#B A2$ &0/0$%6 :8#&/"(40 +$)4R 403

(,06+4(6? 403 4(6&4))# (240:$ 62$ '24F$ ,D 62$ &%6#)$//0-" /"-#,D 62$ $#$= A2/' 4)6$+' 62$

3/'640($ D,+ K2/(2 40 $#$ /' /0 D,(&'= A2$ 4(6/,0 ,D 62$ &0/0$%6 :8#&/"/' )/M$ 62$ D,(&'/0: 3/4) ,0,&+ (4.$+4=

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F+$G$06 )/:26 D+,. $06$+/0: 62$ $#$=

a/0/0: 62$ /0'/3$ ,D 62$ -4(M /0'/3$ '&+D4($ ,D 62$ $#$ /' 4 62/0 )4#$+ ,D 6/''&$ (4))$3 62$ %")0-$=

A2/' /' 62$ )/:26 '$0'/6/G$ '6+&(6&+$ /0 62$ $#$ 403 /' 404),:,&' 6, 62$ D/). /0 4 (4.$+4? ,+ 62$

$)$(6+,0/( 3$6$(6,+' `F/R$)'c /0 4 3/:/64) (4.$+4=


22/112


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(2/)3=

A2$+$ 4+$ '/R .&'()$' 6246 '6$$+ 62$ $#$? K2/(2 (40 -$ (,.F4+$3 6, 62$ 2403' ,D 62$

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6246 4 F$+',0 (40 Y'6$$+Z 2$+ $#$' 6,K4+3 K246$G$+ '2$ K/'2$' 6, '$$=

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&03$+'6403 /6 -$66$+= 5 %"=%$&)0," "%%*%3$'(+/-$' 62$ '/6&46/,0 K2$0 40 $#$ /' ,&6 ,D D,(&'= W6

.$40' 6246 :6*40$`-"$%#0E')"1-"##c? '64"%*40$ =$%#0E')"1-"##c ,+ $#)0E:$)0#:/' F+$'$06= WD

K$ +$6&+0 6, ,&+ 404),:# ,D 4 (4.$+4? 4 %"=%$&)0," "%%*%.4# -$ )/M$ 24G/0: 4 F$+D$(6)# :,,3 403

F$+24F' $RF$0'/G$ (4.$+4? -&6 0,6 D,(&'/0: /6 F+,F$+)#= W6 /' 0,6 4 K$4M (4.$+4 ,+ 4 -43

(4.$+4= W6 /' '/.F)# 4 (4.$+4 6246 /' ,&6 ,D D,(&'= I/./)4+)#? 40 $#$ K/62 4 +"=%$&)0," "%%*%/' 0,6 4

K$4M $#$= W6 /' '/.F)# 40 $#$ 6246 /' ,&6 ,D D,(&'= "#$:)4''$' (,064/0 )$0'$' 6246 (40 D,(&' 62$

/.4:$ '24+F)# ,0 62$ %")0-$403 ()$4+ &F -)&++# G/'/,0= %&(2 4' /0(2$' 4+$ &'$3 D,+ .$4'&+/0:

)$0:62? 403 F,&03' D,+ .$4'&+/0: K$/:26? 62$ &0/6 D,+ .$4'&+/0: 62$ '6+$0:62 ,D 4 )$0' /' 4

10*4)"%= A2$ .,+$ 10*4)"%#,D F,K$+ /0 4 )$0'? 62$ '6+,0:$+ `403 62/(M$+c /6 /'=50 $#$ 6246 24' 0, %"=%$&)0," "%%*%? `24' 0$/62$+ :6*40$? '64"%*40$? 0,+ $#)0E:$)0#:D? /' '4/3

6, -$ "::")%*40&? ,+ Y0$&6+4)=Z A2/' .$40'? -# 3$D/0/6/,0? 6246 K2$0 62$ D,(&'/0: .&'()$ ,D 62$

$#$ `62$ &0/0$%6 :8#&/"c /' +$)4R$3? 62$ $#$ /' /0 D,(&' D,+ D4+ 3/'6406 ,-V$(6'= 1,0'$X&$06)# /D 62/'

'4.$ 0,+.4) $#$ ),,M' 46 ',.$62/0: (),'$ &F? 62$ ,-V$(6 K/)) 4FF$4+ ,&6 ,D D,(&'? ,+ -)&++$3=

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F/(6&+$ K/)) -$ ,&6 ,D D,(&'=


23/112


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4 0,+.4) $#$= 1,0'$X&$06)# )/:26 +4#' $06$+/0: 62$ $#$ (,.$ /06, '24+F D,(&' ',.$K2$+$ /0 62$


24/112


./33)$ ,D 62$ $#$? -$D,+$ 62$# D4)) ,0 62$ +$6/04= W0 )4# 6$+.' 62/' /' +$D$++$3 6, 4' -"$%#0E')"1=

`'$$ F4:$' NS\_Oc

ED).-


25/112


62$ ($06$+ ,D 62$ :$&8/$/' 4 F/0F,/06 '/b$3 'F,6 (4))$3 62$=*,"$= A2$=*,"$F+,G/3$' 62$ G$+#

'24+F$'6 G/'/,0= B2$0 #,& ),,M Y46Z ',.$62/0:? /6' /.4:$ /' D4))/0: ,0 #,&+=*,"$403 $G$+#62/0:

6, 62$ '/3$ ,D K246 #,& 4+$ ),,M/0: Y46Z /' '$$0 K/62 F$+/F2$+4) G/'/,0= 5)62,&:2 62$ G$+# ($06$+

,D 4 F2,6,:+4F2 ./:26 (,064/0 62$ .4/0 '&-V$(6 ,D 62$ F/(6&+$? 62/' 4+$4 ,D F2,6,:+4F2 /' 0,6

+$4))# 62$ $X&/G4)$06 ,D 62$ :$&8/$= B/62 F2,6,:+4F2#? 62$ $06/+$ 4+$4 ,D 4 F/(6&+$ (40 -$

$X&4))# '24+F 403 ()$4+= W0 62$ $#$? 62$ :$&8/$/' 62$ ,0)# F4+6 ,D 62$ %")0-$6246 /' (4F4-)$ ,DF$+($/G/0: 40 /.4:$ 6246 /' '24+F$+ 6240 NOfNOO=

Fig 2-2A) The light rays coming from the sailboat fall on the fovea. The image of

the sailboat will appear sharp. B) The tree is not straight ahead of the eye, so it will

be seen with peripheral vision. The light rays coming from the tree fall on the

peripheral retinainstead of the fovea. It will not be seen a clearly as the sailboat in

Fig 2-2A.

/58 /7


26/112


"*:0%#)* ;%2&5,0-


27/112


Fig 2-4This shows the emmetropicor neutral eye. A) In the relaxed state it is in

sharp focus for distant objects. The sailboat would be seen clearly B) The image

of a near object would impinge on the retina of a neutral eye before it comes

into focus if the ciliary muscleis relaxed. The point at which the image would be

focused lies somewhere behind the retina. C) If the focusing muscle contracts and

makes the shape of the lens more convex, the image of a near object will be

sharply focused on the retina resulting in a clear picture.

"*:0%#)* ;%2&5,0-


28/112


Fig 2-5.A) Distant objects would not be in sharp focus on the retina in a hyperopic

eye if the ciliary muscle is relaxed. They would be in focus behind the retina. B) If

the focusing muscle contracts and makes the shape of the lens more convex

(accommodation), the image of distant objects will be sharply focused on the retinaresulting in a clear picture. C) If the eye does not have the ability to accommodate

sufficiently to correct for hyperopia, either because of a large amount of hyperopia

or older age, a convex lens in front of the eye will serve the same purpose as

accommodationand bring the image in sharp focus on the retina. D) The image of

near objects would be even more out of focus on the retina of a hyperopiceye

when the ciliary muscle is relaxed. The point at which they would come into focus

lies even further behind the retina than for distant objects. E) Accommodatingeven

more than is needed for distance viewing will place the images of the near objects

in sharp focus on the retina of a hyperopiceye. F) If the eye does not have the

ability to accommodatesufficiently to correct for hyperopia,or cannot perform the

additional accommodationneeded for near viewing, either because of a large

amount of hyperopiaor older age (presbyopia), an even stronger convex lens infront of the eye is needed to bring a near image in sharp focus on the retina. Thus

if a person needs a different spectacle lens for distance and near viewing, a

bifocal is needed.

A2&' D,+ 62$ '64"%*40& P=$%#0E')"1D $#$? 0$4+ G/$K/0: +$X&/+$' .,+$ $DD,+6 6240 3/'640($

G/$K/0:? -&6 G/'/,0 /' 0,6 0$($''4+/)# K,+'$ D,+ G/$K/0: 0$4+ ,-V$(6'= 5 #,&0: F$+',0 K2, /'

'64"%*40& P=$%#0E')"1D .4# '$$ K$)) 46 3/'640($ 403 0$4+ K/62,&6 :)4''$'? -$(4&'$ '2$ (40


29/112


$4'/)# (,.F$0'46$ D,+=$%#0E')"1-"##`-# $&&*::*1$)0-Ec= B/62 /0(+$4'/0: 4:$ 403 3$(+$4'/0:

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G/$K/0:? K2$+$ .,+$ $&&*::*1$)0*-/' 0$$3$3= a46$+? 4' 62$ 4-/)/6# 6, $&&*::*1$)":$6' $G$0

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62$ 0,+.4) '/6&46/,0= %,'6 (2/)3+$0 3, 0,6 0$$3 :)4''$' 6, (,++$(6 /6? -$(4&'$ 62$# (40 $4'/)#$&&*::*1$)"403 (,.F)$6$)# (,.F$0'46$ D,+ 62/' 4.,&06 ,D '64"%*40$=

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G/$K/0:? 62$+$ /' 0, $X&4) -&6 ,FF,'/6$ F+,($'' 6, $&&*::*1$)0*-K2/(2 (,&)3 (4&'$ 62$ )/:26

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=0.


33/112


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K246 4(6&4))# 24FF$0' -$(4&'$ $4(2 ,D #,&+ $#$' K,+M' )/M$ 4 (4.$+4=W0 433/6/,0?=8#0*-/' 4/3$3 -# 62$ /.4:$' D+,. $4(2 $#$ -$/0: $X&4))# ()$4+= WD 62$ /.4:$' ,D

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62$ ,62$+ G$+# -)&++$3? ,+ /D #,&+ 6K, $#$' 4+$ 0,6 ),,M/0: 46 62$ '4.$ ,-V$(6 `,0$ $#$ ),,M/0:

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'$$ 6K, ,D $G$+#62/0:= I.4)) 62/0:'? )/M$ 62$ F+/06 ,0 62/' F4:$ K,&)3 -$ F4+6/(&)4+)# 3/DD/(&)6 6,

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40# $DD,+6 ,+ 62,&:26 ,0 #,&+ F4+6= A2/' 24FF$0' G$+# +4F/3)# k 4' 4&6,.46/(4))# 4' 62$

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"#$' .,G$ -$(4&'$ 62$ -+4/0 6$))' 62$. 6,? $/62$+ (,0'(/,&')# ,+ '&-(,0'(/,&')#? -#

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'&+D4($ ,D 62$ $#$c 6, +$)4R ,+ (,06+4(6= "4(2 $#$ 24' '/R ,D 62$'$ .&'()$'= `'$$ ^/:&+$ _\Nc=


34/112


Fig 3-2The location of the six extraocular muscles of a right eye. The medial

rectus rotates the eye inward toward the nose. The lateral rectus rotates the eye

outward toward the ear. The superior rectus and the inferior oblique muscles

rotate the eye upward. The inferior rectus and the superior oblique muscles rotate

the eye downward. These muscles are on the surface of the eye under the white

layer of conjunctiva. The 4 rectus muscles are approximately 4 to 8 millimeters

back from where the white meets the colored part of the eye; the 2 oblique

muscles lie farther back.

A2$+$ 4+$ 62+$$ .4V,+ 0$+G$' 6246 (,.$ D+,. 62$ -+4/0 6, 62$'$ .&'()$' 403 (,06+,) 62$/+

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4&6,.46/(4))# 403 /0 D+4(6/,0' ,D 4 '$(,03=

/7) G8). 0. 0 /)0,

A2$ .,G$.$06 ,D 62$ 6K, $#$' 4' 4 6$4. (40 -$ 4F6)# (,.F4+$3 6, 4 6$4. ,D 2,+'$'=

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$R6+4,(&)4+ .&'()$' .,G$ 62$ $#$'= "4(2 2,+'$ /0 ^/:&+$ _\_ 24' 4 6,64) ,D '/R +$/0' 6,


35/112


(,06+,) /6' 62$ 3/+$(6/,0 ,D /6' 2$43? ,0$ 6, 6&+0 +/:26? ,0$ )$D6? 6K, 6, F&)) /6 &FK4+3? 403

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'/3$ ,D 62$ 2,+'$[' 2$43=

Fig 3-3In this team of horses each horse has three reins running to each side of its

head instead of the usual single rein. Keeping each horse facing exactly the same

direction is difficult, because it is necessary to pull equally on the proper reins at

the same time. Just as the reins turn the horses heads, each eye is controlled by

six extraocular muscles, which pull the eyes to turn them in specific directions. The

very accurate ability of the eyes to team together seems even more remarkable

when one realizes what a complicated mechanism is involved=

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" =Fig 4-1A) A photograph of a baby with pseudostrabismus . Although in this picture

it appears as though his left eye is turning inward, it is in fact perfectly aligned

with his right eye. This normal child is merely looking slightly to his right. His widebridge of the nose covers most of the adjacent white of the left eye, giving the

false appearance of strabismus. One way your doctor can tell that the eyes are

properly aligned is by studying the reflection of a light in the pupils. If the eyes

are pointing in the same direction, the light reflection (in the above photograph it

is created by the camera flash) will be symmetrically positioned in the two eyes as

seen in this photograph. B) A photograph of a baby with a crossed right eye. Note

that the light reflections from the camera are not symmetrically located in the two

eyes. The right eye is turned in.

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3 K

Fig 4-2Types of strabismus. A) Esotropia(right eye is turned in towards nose). B)

Exotropia(left eye is turned out toward ear). C)

Hypertropia(left eye is turned upward). D) Hypotropia(right eye is turned

downward).

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" =Figure 4-3A) These two girls are mirror image identical twins. The twin on your left in the

photo has a right eye that is turned in. Her sister, on your right in the photo has a left eye

that is turned in. B) Both girls required glasses which essentially had identical prescriptions.

With their glasses on, their eyes were properly aligned.

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Fig 5-2Child with esotropiawith alternating fixation. At times he looks with his

right eye and the left eye crosses (right photo). At other times he looks with his left

eye and the right eye crosses (left photo).

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Fig 5-4Decorating the eye patch and placing a similar patch on a childs favorite toy

animal may help overcome resistance to patching.

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Figure 6-2A) This shows a girl with a crossed left eye. B) If you make her look with

the left eye by occluding her right eye, her left eye straightens. If you peek behind

whatever is occluding her right eye, you will see that it is turned in behind the

occluder.

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/0D406/)$ "#*)%*40$/' 3$'/+4-)$= ;$(4&'$ (2/)3+$0 K/62 /0D406/)$ "#*)%*40$4+$ F+,-4-)# -,+0K/62,&6 62$ 0,+.4) 4-/)/6# D,+ 62$ $#$' 6, K,+M 6,:$62$+? 62$# &'&4))# 3, 0,6 3$G$),F F$+D$(6)#

0,+.4)=8#0*-,+ #)"%"*4#0#`_\@ G/'/,0c 4D6$+ '&(($''D&) '&+:$+# 6, +$4)/:0 62$/+ $#$'=

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-$66$+=8#0*-6240 /D '&+:$+# /' 3$)4#$3 &06/) 4 )46$+ 4:$= 1,0'$X&$06)#? .40# *4')'$/:*/*E0#)#

F+$D$+ 6, F$+D,+. '&+:$+# -# Q\e .,062' ,D 4:$? F+,G/3$3 62$ ,62$+ 0$($''4+# '6$F' 24G$ -$$0

64M$0 D/+'6=

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Figure 6-4A) Normal eyes looking at a sailboat in the distance, and B) at a near

object. The ciliary muscle(or focusing muscle) is thin and relaxed when looking at a

distant object as shown in A. This muscle is noticeably thickened and contracted

when looking at near objects as seen in B. By means of the ciliary muscle, the eye

accommodatesitself for objects at varying distances, hence the process is known as

accommodation. In addition, when the eyes accommodateand look close up, they

also converge(or turn in a bit) as seen in B so both eyes point toward the close upwristwatch.

A2/' +$D)$R /' &'$D&) 403 2$)FD&) /0 0,+.4) (2/)3+$0? -&6 /6 (40 )$43 6, F+,-)$.' K2$0 62$+$ /'

.,+$ 6240 62$ 4G$+4:$ 4.,&06 ,D '64"%*40$= U$(4)) 6246 .,'6 #,&0: (2/)3+$0 4+$ 4 -/6=$%M

#0E')"1-# 4-,&6 P\N 10*4)"%#`62$ &0/6 -# K2/(2 %"=%$&)0," "%%*%#4+$ .$4'&+$3c= 12/)3+$0 (40

(,.F$0'46$ D,+ 62/' 403 '$$ ()$4+)# K/62,&6 :)4''$' -# $&&*::*1$)0-E= ;&6 K246 24FF$0' /D 4

(2/)3 /' .,+$ '64"%*40& P=$%#0E')"1D6240 0,+.4)h C$ (40 '6/)) '$$ ()$4+)# K/62,&6 :)4''$'? -&6 2$

0$$3' 6, $&&*::*1$)".,+$ 6240 0,+.4) 6, ()$4+ &F 62$ G/'/,0= ;$(4&'$ ,D 62$ +$D)$R 6246

-/03' $&&*::*1$)0*-6, &*-,"%E"-&"? 2/' $#$' (+,''= W0 4 '$0'$? 62/' (2/)3 24' 62$ '&-(,0'(/,&'

(2,/($ -$6K$$0 24G/0: $G$+#62/0: -)&++$3 `-$(4&'$ 2$ /' 0,6 $&&*::*1$)0-Ec 403 2/' $#$'

'6+4/:26? ,+ ()$4+/0: &F 62$ /.4:$ `-# $&&*::*1$)0-ED 403 24G/0: 2/' $#$' (+,''= A246 /' K2#

62/' F+,-)$.? (4))$3 4((,..,346/G$ "#*)%*40$,+ %"=%$&)0,"$',6+,F/4? 6#F/(4))# 3$G$),F' 4-,&6

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4:$c? 4)62,&:2 /6 ,((4'/,04))# ,((&+' /0 #,&0: /0D406'=

A2$+$ /' 4 '$(,03 .$(240/'. -# K2/(2 $&&*::*1$)0*-(40 (4&'$ $',6+,F/4= W0 62$ 4-,G$

$R4.F)$? K$ )$4+0$3 6246 "#*)%*40$(40 ,((&+ /D 4 (2/)3 /' .,+$ '64"%*40&P=$%#0E')"1D 6240

0,+.4)= 5#*)%*40$(40 4)', ,((&+ $G$0 /D 4 (2/)3 24' 62$ 0,+.4) 4.,&06 ,D '64"%*40$? /D 62$


64/112


+$D)$R 6246 (,&F)$' $&&*::*1$)0*-6, &*-,"%E"-&"/' 2#F$+4(6/G$= J,+.4))# (2/)3+$0 &*-,"%E"

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+$)46/,0'2/F /' :+$46$+? 403 4 (2/)3 (,0G$+:$' .,+$ 6240 62$ 0,+.4) 4.,&06 D,+ $4(2 10*4)"%

62$# $&&*::*1$)"? 62$+$ K/)) -$ $R($''/G$ &*-,"%E"-&"? 403 62$ $#$' K/)) -$ (+,''$3= W0 62/'

'/6&46/,0? 4)', (4))$3 4((,..,346/G$ "#*)%*40$? 62$ $#$' (+,'' .,+$ 4' 4 (2/)3 ),,M' (),'$ &F 46

4 -,,M 6240 K2$0 2$ ),,M' 46 4 6$)$G/'/,0 4(+,'' 62$ +,,.? -$(4&'$ .,+$ $&&*::*1$)0*-/'0$$3$3 D,+ (),'$+ G/$K/0:=

B2$0 "#*)%*40$/' (4&'$3 -# $&&*::*1$)0*-/0 $/62$+ ,D 62$ K4#' 3$'(+/-$3 4-,G$? 62$

(,03/6/,0 /' (4))$3 $&&*::*1$)0," "#*)%*40$B

9&' K&).+22.((.>$"&64 7'."#./&$=)70:)>

W0 62$ $4+)# '64:$'? $&&*::*1$)0," "#*)%*40$/' (24+4(6$+/b$3 -# 4 G4+/4-)$ 403 /06$+./66$06

(+,''/0: ,D 40 $#$= A2$ (+,''/0: /' .,+$ )/M$)# 6, ,((&+ K2$0 4 (2/)3 /' D,(&'/0: ,0 '.4)) ,-V$(6'

`$'F$(/4))# 46 0$4+c? 6/+$3? ,+ /))= EG$+ 4 F$+/,3 ,D 34#' 6, .,062'? 62$ (+,''/0: K/)) -$(,.$ .,+$

D+$X&$06 403 &)6/.46$)# -$(,.$ (,0'6406)# F+$'$06= U$.$.-$+? 62$ (2/)3 /' '&-(,0'(/,&')#

(2,,'/0: -$6K$$0 -)&++$3 G/'/,0 403 '6+4/:26 $#$'? ,+ ()$4+ G/'/,0 K/62 (+,''$3 $#$'= 5D6$+ 4'2,+6 F$+/,3 ,D 6/.$? :/G$0 6246 (2,/($? 62$ (2/)3 4)K4#' (2,,'$' 6, '$$ ()$4+)#= 56 6246 6/.$ 62$

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(2/)3 .4# (,.F)4/0 ,D '$$/0: 3,&-)$ K2$0 62$/+ $#$ (+,''$'? /D 62$# 24G$ 0,6 #$6 '64+6$3 6,

3$G$),F #844%"##0*-= I,.$6/.$'? 4 2/:2 D$G$+? /0D$(6/,&' /))0$''? ,+ 2$43 /0V&+# .4# .4M$ /6

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$&&*::*1$)0," "#*)%*40$ .4# 3$G$),F= W0 6246 (/+(&.'640($? 62$ 2/:2 D$G$+? /0D$(6/,&' /))0$''?

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K2/(2 40 /0$G/64-)$ F+,-)$. -$(4.$ $G/3$06=

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$&&*::*1$)0," "#*)%*40$/' 6, (,++$(6 62$ &03$+)#/0: (4&'$ ,D 62$ F+,-)$.= A2/' /0G,)G$'

:)4''$' 6, (,++$(6 D,+ 62$ '64"%*40$= 5D6$+ :)4''$' 4+$ F+$'(+/-$3? $:9/6*40$`/D F+$'$06c .&'6

-$ 6+$46$3 /0 62$ F+$G/,&')# 3$'(+/-$3 .400$+= W0 ',.$ (2/)3+$0 K/62 $&&*::*1$)0,"

"#*)%*40$? 62$ $#$' 4+$ K$)) 4)/:0$3 K/62 :)4''$'? 403 0,62/0: D&+62$+ 0$$3' 6, -$ 3,0$ 6, 6+$46

62$ (+,''/0:= A2$ $#$' K,+M K$)) 6,:$62$+ K2$0 62$ :)4''$' 4+$ ,0= A2$# K/)) (,06/0&$ 6, (+,''

K2$0 :)4''$' 4+$ ,DD? 2,K$G$+? -$(4&'$ $R($''/G$ $&&*::*1$)0*-/' 4:4/0 0$$3$3 6,

(,.F$0'46$ D,+ 62$ '64"%*40$= A2$ :)4''$' 24G$ 0,6 $)/./046$3 62$ '64"%*40$? -&6 .$+$)#

D,(&'$3 62$ /.4:$' D,+ 62$ $#$'=5' $RF)4/0$3 4-,G$? ',.$ (2/)3+$0 K/62 $&&*::*1$)0,""#*)%*40$.4# 24G$ 4 0,+.4)

4.,&06 ,D '64"%*40$-&6 24G$ 4 2#F$+4(6/G$ +$D)$R )/0M/0: $&&*::*1$)0*-6, &*-,"%E"-&"= 5' 4

+$'&)6? 62$/+ $#$' (+,'' .,+$ D,+ 0$4+ G/'&4) 4(6/G/6/$' )/M$ (,),+/0:? +$43/0: 4 -,,M? ,+ ),,M/0:

(),'$)# 46 62$/+ F4+$06[' D4($= 1,0'$X&$06)#? 62$# 0$$3 :)4''$' 6246 F+,G/3$ .,+$ (,++$(6/,0 D,+

(),'$ &F G/$K/0: `K2$+$ 62$ F+,-)$. /' :+$46$'6c 6240 D,+ D4+ 4K4# k 'F$(/D/(4))# 62$# 0$$3

90=*&$/#= 5)62,&:2 K$ ,D6$0 62/0M ,D 90=*&$/#4' ',.$62/0: ,)3$+ F$,F)$ 0$$3? /D #,& 62/0M 4-,&6

62/'? /6 '2,&)3 '$$. '$0'/-)$= A2$ $#$ (+,''/0: /' :+$46$+ 46 0$4+? 62&' .,+$ (,++$(6/,0 /' 0$$3$3


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D,(&'/0: 0,6 $&&*::*1$)0-ED 2$ /' ,0)# (+,''$3 PO 3$:+$$'? -&6 2/' G/'/,0 /' -)&++$3= C$ K406'

6, '$$ ()$4+)#? ', 2$ .&'6 $&&*::*1$)" `D,(&' 2/' $#$'c 6, (,.F$0'46$ D,+ 2/' '64"%*40$= ;&6

-# 3,/0: ',? 2/' $#$' (+,'' 62$ 433/6/,04) NO 3$:+$$' `6, .4M$ 4 6,64) ,D _O 3$:+$$' ,D (+,''/0:c?

-$(4&'$ ,D 62$ (),'$ )/0M/0: ,D $&&*::*1$)0*-6, &*-,"%E"-&"B B246 K,&)3 24FF$0 /D '&+:$+#

K4' F$+D,+.$3 6, (,++$(6 62$ $06/+$ _O 3$:+$$' ,D (+,''/0: k 62$ 4.,&06 6246 /' F+$'$06 K2$0

2$ /' 0,6 K$4+/0: 2/' :)4''$' 403 $&&*::*1$)0-Ek D,+ 62$ F&+F,'$ ,D $)/./046/0: 2/' 0$$3 D,+:)4''$'h 5D6$+ '&+:$+#? 2/' $#$' K,&)3 0,6 -$ (+,''$3 K2$0 2$ /' 0,6 K$4+/0: :)4''$'? 4' ),0: 4'

2$ K4' $&&*::*1$)0-E6, ,G$+(,.$ 2/' '64"%*40$= C,K$G$+? $&&*::*1$)0-E(,06/0&,&')# /'

D46/:&/0:? 403 2$ K,&)3 F$+/,3/(4))# 0$$3 6, +$)4R 2/' D,(&'/0:= B2$0 2$ 3,$' ',? 2/' $#$' K,&)3

10,"%E"62$ NO 3$:+$$' 6246 K4' -$/0: (,06+,))$3 -# $&&*::*1$)0*-? 403 2$ K,&)3 4FF$4+ NO

3$:+$$' "G*)%*40& `24' 40 $#$ 6246 3$G/46$' ,&6K4+3 k YK4))\$#$3ZcB ;$/0: NO 3$:+$$'

"G*)%*40& /' 0, -$66$+ 6240 -$/0: NO 3$:+$$' &%*##M"6"1i I/./)4+)#? /D 2$ $G$+ 3/3 K$4+ 2/'

:)4''$'? K2/(2 F$+24F' 2$ .4# 0$$3 6, 3, 6, F+$G$06 $#$'6+4/0 ,+ -)&++$3 G/'/,0? 62$ '4.$

62/0: K,&)3 24FF$0= A2$ :)4''$' K,&)3 (4&'$ 2/. 6, +$)4R 2/' $&&*::*1$)0*-403 "G*)%*40$

K,&)3 +$'&)6=

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67)% X7&D(* ;%-)5,


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/0 (,0V&0(6/,0 K/62 "#*)%*40$,+ "G*)%*40$=

W0 62$ (,&+'$ ,D 0,+.4) 34/)# 4(6/G/6#? K$ D+$X&$06)# .4M$ .,+$ 2,+/b,064) 43V&'6.$06' /0

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3/'6406 ,-V$(6 '$$0 62+,&:2 4 K/03,K? 6, 4 F4:$ /0 4 -,,M (),'$\&F? 403 62$0 6, 62$ (),(M ,0

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4' K$ 24G$ 4)+$43# 3/'(&''$3? D,(&'/0: 403 $&&*::*1$)0*-K/)) (4&'$ $#$' 6, &*-,"%E",+

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4+$ )$'' )/M$)# 6, +$'F,03 6, $#$ $R$+(/'$' ,+ '/.F)$ :)4''$'= WD G$+6/(4) #)%$90#:8# /''/:0/D/(406? /6

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6+$46.$06 K/624%0#:#/0 'F$(64()$' `'$$ (24F6$+ POc= A2/' /' .,+$ )/M$)# 6, -$ 62$ (4'$ K/62

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2$434(2$'? ,+ $#$ '6+4/0=

O)5-


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O)5-


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" =

Figure 6-6A) Child with V pattern esotropia. Eyes are more crossed looking downand less crossed looking up. B) Man with an A pattern esotropia. Eyes are properly

aligned looking down and more crossed looking up=

5 403 H F466$+0' 4+$ ,D6$0 (4&'$3 -# $R($''/G$ ,+ 3$D/(/$06 4(6/,0 ,D ',.$ ,D 62$ G$+6/(4)

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370A-)5 a

XD5+


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Fig 7-1This view of a right eye is very similar to what an ophthalmologistwould

see during strabismussurgery. The eyelids are gently held apart by a speculum.

The muscles lie on the outside of the eyeball, just underneath the conjunctiva, which

is a thin membrane covering the eyeball. In this drawing, the conjunctiva is

reflected to the side and held by two forceps in order to expose themedial rectus

muscle. There is an L-shaped surgical instrument (called a muscle hook) under

the muscle. The other extraocular musclescannot be seen in this drawing, because

they are covered by the conjunctivaand are in different locations.

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K$$M' 4D6$+ '&+:$+# 403 3, 0,6 0$$3 6, -$ +$.,G$3=

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'4D$)# 3, ',i

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B0#-@ 5)62,&:2 )4'$+' 4+$ &'$3 X&/6$ $R6$0'/G$)# /0 ,62$+ 6#F$' ,D $#$ '&+:$+#? 62$# 4+$

0,6 &'$3 403 K,&)3 -$ ,D 0, -$0$D/6 D,+ #)%$90#:8#'&+:$+#= a4'$+' 4-)46$ `+$.,G$c 6/''&$ 403K$ 3, 0,6 K406 6, +$.,G$ 62$ $#$ .&'()$'=

L&&.)%


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4664(2.$06 /' 62$0 '$F4+46$3? 403 62$ .&'()$ /' +$\4664(2$3 6, 62$ $#$ &'/0: 62$ F+$G/,&')#

F)4($3 '&6&+$'= `'$$ ^/: T\Nc=

Fig 7-2In a recession operation, sutures are placed in the muscle, the muscle is

detached from the eye, and is re-attached to a new location behind the original

one=

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./'4)/:0$3= A2$ D&+62$+ 62$ .&'()$ /' Y+$($''$3Z `.,G$3 -4(Mc? 62$ :+$46$+ 62$ (240:$ /0 62$

F,'/6/,0 ,D 62$ $#$=

/


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edge of the remaining muscle is attached to original attachment site, thus placing

the muscle on stretch.

4(0%%


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Fig 7-5A) Esotropia with left eye turned inward. B) Recession of the in-turning

muscle in each eye will correct the strabismus.

WD $#$' 4+$ "G*)%*40&`L$//M"6"1c? '&+:$+# ./:26 /0G,)G$ +$($''/0: 62$ ,&6\6&+0/0: .&'()$ /0

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Fig 7-6A) Exotropia with the left eye turned outward. B) Recession of the out-

turning muscle in each eye will correct the strabismus.


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Fig 7-7A) Exotropia with the left eye turned outward. B) Recession of the out-

turning muscle and resection of the in-turning muscle in the left eye will correct the

strabismus.

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81/112


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Fig 10-2Proper positioning of a bifocal for a child with esotropia. The bifocal line

is level with the mid-pupil.

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KFigure 13-2This girl has Duane Syndrome of her right eye. B) When she looks

straight ahead her eyes are properly aligned. A) When she looks to her right, her

right eye does not move past the midline position. Sometimes parents feel this

situation is an abnormal crossing of the left eye, when in fact the problem is that

the right eye cannot rotate to the right. C) When she looks to her left, the righteye is pulled back in the eye socket causing the opening of the eyelids to narrow

and the eye look smaller. D) When looking in the distance she turns her face a bit

to the right because her eyes line up better in that position.

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eye muscle problems in children and adults

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