Eyes Right and Down---Not Eyes Down and Right

NOTES, CASES, INSTRUMENTS fected, the change has caused no incon­ venience. It is only necessary to replace the droppers with stoppers—the droppers themselves may be utilized as part of the supply of sterile droppers to be used afresh for each patient. Where several drops of the same medicament are to be used in the same eye, as in the case of local anesthetics and mydriatics, a sufficient quantity may be drawn into the dropper at one time to suffice for the requisite number of drops. If one drop only is to be used, care must be exercised not to waste the solution by withdrawing more than the minimum amount to be used. Economy may also be practiced by the use of a glass rod to which one drop and no more of the solu­ tion will adhere by capillarity—a par­ ticularly good hint in the use of fluorescein and other dyes. Although sterilizing kills germs, it does not destroy the chemical activity of all the various medicines used for eye drops, and it is therefore necessary thoroughly to wash and rinse eye droppers before boil­ ing them. Even with this precaution, it may be advisable to have distinctive drop­ pers for use with mydriatics and keep them separate from the others to avoid the occasional undesirable effect of con­ tamination. 121 East Sixtieth Street.

EYES R I G H T A N D DOWN—NOT EYES DOWN AND RIGHT THOMAS D. ALLEN,

M.D.

Chicago From reading the literature and from contacts with graduate students, I have concluded that one of the great difficulties students and many practicing ophthal­ mologists experience in the comprehen­ sion of the functions and actions of the individual ocular muscles, springs from

1209

our use of words. Instead of thinking of the primary position as the origin of ro­ tations no matter which ocular muscle is stimulated, we should think of the three cardinal positions : 1, eyes straight; 2, eyes right ; and 3, eyes left. From each of these positions as a starting point, only two muscles of each eye act in a simple, un­ complicated way. 1. Eyes straight (a) median rectus )~ (b) lateral rectus j 2. Eyes right (a) superior rectus } „ (b) inferior rectus ( (c) superior oblique) (d) inferior oblique \ 3. Eyes left (a) superior rectus ) T (b) inferior rectus { (c) superior oblique ) Ώ (d) inferior oblique (

,

T

When we say "eyes right and down" we mean the attention is turned downward from the eyes' right position. From this position only one muscle of each eye moves the eye down; namely, the right inferior rectus and the left superior oblique. If we say "eyes down and right" we think of the eyes turning right from the reading position; that is, the move­ ment to the right is emphasized by the statement ; and this makes us think of the right externus and the left internus, not the right inferior rectus or the left su­ perior oblique. We cannot easily investigate the simple downward rotation of the right eye by having the patient look down first and then to the right. This is because 1, the reading position of the eyes is the result of the combined action (three muscles of each eye) of both of the depressors and of the internus of each eye, and, 2, the motion to the right from the eyes down position is the result of the action of the

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NOTES, CASES, INSTRUMENTS

right externus (and less so of the two obliques) and of the left internus (and less so of the superior and inferior recti). In investigating the ocular muscles, the simpler the technique the more accurate the findings. For the median and lateral recti we start with the eyes in the primary position; for the left obliques we start with the eyes right, for the right obliques with the eyes left; and for the superior and inferior recti we start with the eyes toward the side of the eye under question. From the last two cardinal positions (that is, eyes right and eyes left) the eyes are directed upward or downward, respec­ tively, to investigate the elevators or de­ pressors. May I therefore respectfully suggest that we change the phrase "down and right" to "right and down"; "down and left" to "left and down" ; "up and right" to "right and up"; "up and left" to "left and up." This is not the first time this subject has been brought to our attention ; but it is worth repeating because of its extreme simplicity. 122 South Michigan Avenue.

CLOSURE OF THE SCLERA AFT­ ER REMOVAL OF INTRAOCU­ LAR FOREIGN BODY BY THE POSTERIOR ROUTE WALLACE

C. B E I L ,

M.D.

New Orleans

The point of incision of the sclera is selected, and the bulbar conjunctiva is incised, exposing the sclera. The sclera is incised through approximately two thirds of its thickness in a similar manner as for cyclodialysis. A piece of 6-0 silk on an atraumatic needle is placed through the two lips of the wound and the threads drawn up in a loop from the bottom of the wound (diagram). After completion of the incision, these can be used as trac­

tion sutures to make the wound gape for the insertion of instruments and the re­ moval of the foreign body. After removal of the foreign body the ends of the sutures

Fig. 1 (Beil). Cross section showing sutures used for traction. Fig. 2 (Beii). Suture closing wound.

are drawn together and tied, giving a firm closure and, if cut short, can be left buried. 812 Maison Blanche Building.

A N E W MATERIAL FOR ANTERIOR-SEGMENT IMPRESSIONS H. SAUL SUGAR, MAJOR (MC), Vancouver, Washington

A.U.S.

Technical advances in one field of sci­ ence frequently lead to improvements in the methods used in other fields. Such has been and remains the case as regards ma­ terials for making impressions of the mouth prior to fitting artificial dentures, and in the making of impressions of the anterior segment of the eye for molded contact lenses. The various impression materials used in the making of molded contact lenses in-