It is easy to show that a squinting person very seldom, if ever, sees an object with the distorted eye. Indeed in above forty cases that I have examined, I found that when I placed an opaque body between the undistorted eye and the object, it immediately disappeared, nor were they able to see it at all, till they directed the axis of the distorted eye to the object. I find the same observation made by Dr. Reid and M. Buffon.
M. Buffon takes notice of a fact which I have often observed; viz. that many persons have their eyes very unequal without squinting.
When the difference is very considerable, the weak eye does not turn aside, because it can see almost nothing, and therefore cannot disturb the vision of the good eye. Also, when the inequality is but small, the weak eye will not turn aside, as it affords very little disturbance to the sight of the other: when the inequality consists in the difference of convexity, or difference of the limits of distinct vision, having the limits of distinct vision in each eye given, it may be calculated with some degree of accuracy what degree of inequality is necessary to produce squinting. It seems then that there are certain limits with regard to the inequality of the eyes, necessary to produce this deformity; and that if the inequality be either greater or less than these limits, the person will not squint.
Having now endeavoured to show what is the most common cause of squinting, I shall briefly attempt to point out those cases in which we may expect to effect a cure, and afterwards give a very short account of the most likely methods of doing it.
We cannot have great hopes of success, when there is a very great defect in the distorted eye. When the eyes are of different convexities, there is no other way of removing the deformity, than by bringing them to an equality by means of glasses, and then the person would only look straight when he used spectacles. When this defect is owing to a weakness in the distorted eye, it may sometimes be cured: M. Buffon observes that a weak eye acquires strength by exercise, and that many persons, whose squinting he had thought to be incurable, on account of the inequality of their eyes, having covered their good eye for a few minutes only, and consequently being obliged to exercise their bad one for that short time, were themselves surprised at the strength it had acquired, and on measuring their view afterwards, he found it to be more extended, and judged the squinting to be curable. In order therefore to judge with any certainty of the possibility of a cure, it ought always to be tried whether the distorted eye will grow better by exercise; if it does not, we can have little hopes of success; but when the eyes do not differ much in goodness, and it is found that the distorted eye acquires strength by exercise, a cure may then be attempted: and the best way of doing it, (according to M. Buffon) is to cover the good eye for some time, for, in this condition, the distorted eye will be obliged to act, and turn itself towards objects, which by degrees will become natural to it.
When the eyes are nearly brought to an equality by exercise, but cannot both be directed to the same point, Dr. Jurin's method may be practised, which is as follows.
If the person is of such an age, as to be capable of observing directions, place him directly before you, and let him close the undistorted eye, and look at you with the other; when you find the axis of this fixed directly upon you, bid him endeavour to keep it in that situation, and open the other eye; you will now see the distorted eye turn away from you towards his nose, and the axis of the other will be pointed towards you, but with patience and repeated trials he will, by degrees, be able to keep the distorted eye fixed upon you, at least for some time after the other is opened, and when you have brought him to keep the axis of both eyes fixed upon you, as you stand directly before him, it will be time to change his posture, and set him, first a little to one side of you, and then to the other, and so practise the same thing. And when, in all these situations, he can perfectly and readily turn the axes of both eyes towards you, the cure is effected. An adult person may practice all this before a mirror, without a director, though not so easily as with one: but the older he is, the more patience will be necessary.
With regard to the success of this method, M. Buffon says, that having communicated his scheme to several persons, and, among others, to M. Bernard de Jussieu, he had the satisfaction to find his opinion confirmed by an experiment of that gentleman, which is related by Mr. Allen, in his Synopsis Universae Medicinae. Dr. Jurin tells us that he had attempted a cure in this manner with flattering hopes of success, but was interrupted by the young gentleman's falling ill of the small pox, of which he died. Dr. Reid likewise tried it with success on three young gentlemen, and had brought them to look straight when they were upon their guard. Upon the whole this seems by much the most rational method of attempting to cure the deformity.
The only remaining morbid affections of the eye which I shall take notice of in this lecture, are two, which produce the indistinct vision of an object, by directly opposite means. The first is caused by the cornea, and crystalline, or either of them, being too convex, or the distance between the retina and crystalline being too great. It is evident, that from any of these causes, or all combined, the distinct picture of an object, at an ordinary distance, will fall before the retina, and therefore the picture on the retina itself must be confused, which will render the vision confused and indistinct; whence, in order to see things distinctly, people whose eyes are so formed are obliged to bring the object very near their eyes; by which means the rays fall upon the eye in a more diverging state, so that a distinct picture will be formed on the retina, by which the object will be distinctly seen: from the circumstance of such persons being obliged to hold objects near their eyes, in order to see them distinctly, they are called short sighted.
If a short sighted person look at an object through a small hole made in a card, he will be able to see even remote objects, with tolerable distinctness, for this lessens the circles of dissipation on the retina, and thus lessens the confusion in the picture. For the same purpose, we commonly observe short sighted people, when they wish to see distant objects more distinctly, almost shut their eye lids: and it is from this, says Dr. Porterfield, that short sighted persons were anciently called myopes.