Congenital ocular palsy.

A full-term male infant, weighing 8 lb Ii oz at birth, was delivered by forceps on July I5, I960, because of occipito-posterior presentation. He had a large cephalhaematoma on the right side with considerable bruising and swelling around the right eye, the upper lid of which did not open for one month. When it did open, it was noted that the eye itself did not move, and that the pupil was small and did not react to light. Apart from this, the child was well. At the age of 2 years the findings were as follows: the right palpebral fissure was smaller than the left due to ptosis; it narrowed slightly when the eye was abducted and widened slightly on adduction. The right upper lid became slightly retracted on attempting to look down but the lids closed normally in sleep. Bell's phenomenon was absent. The right eye had almost full movements in the horizontal plane but vertically there was only a very slight amount of elevation in adduction and a very slight amount of depression in abduction (Fig. ia-j). The movements of the left eye were full. The pupil of the right eye was smaller than the left (Fig. ib) and it reacted sluggishly to light and accommodation. The cover test showed that the child maintained binocular vision some of the time, but he easily developed a left divergent squint with a rotatary nystagmus of the left eye. The right eye was occluded to encourage use of the left eye. At the age of 5 years the findings were unaltered, except that the refraction then showed hypermetropic astigmatism, the prescription being R + I D sph., + I D cyl., axis go9; L + o 5 D sph., + 2 D cyl., axis go9. The visual acuity with correction was R 6/6, L 6/24. At II years of age astigmatism had increased, the prescription being R + 2 D sph., + 3.5 D cyl., axis 800; L + o.5 D sph., + 3 D cyl., axis 750; the visual acuity was still R 6/6, L 6/24.