Strabismus in the New Haven Dispensary *

From an analysis of the cases in the Strabismus Clinic in the New Haven Dispensary some facts are presented concerning: 1) the different types of squint; 2) amblyopia; 3) the incidence of surgical advisability; and 4) hypertropias. Muscle cases in the New Haven Dispensary were segregated into a special strabismus clinic, carried on in connection with the regular clinic, during 1933-34. The strabismus clinic was reopened in 1936 and has continued to date. From July, 1936, to the most recent review of the cases this summer (August, 1941), over 400 cases have attended the strabismus clinic. The total number of cases analyzed in this series is 410, of which 31 had no strabismus but appeared in the strabismus clinic because of a question in the diagnosis, because of a high degree of phoria, or because of an unexplained amblyopia. It is common knowledge that internal strabismus is more frequent than divergent strabismus and that alternating strabismus is more common in divergent strabismus than in esotropia. The incidence in this series of 379 cases of definite strabismus confirms these facts: 63 cases, or 17 per cent, are exotropia; 313, or 82 per cent, are esotropia; 4, or 1 per cent, are pure hypertropia. Likewise, in this series 33 per cent (101 cases) of the internal squints are alternators while 59 per cent (39 cases) of the divergent squints are alternators. It must be noted parenthetically that the incidence of alternating strabismus will vary somewhat with the definition of the term. As here used the term includes all those cases who can fix with either eye when both eyes are uncovered. The approach to strabismus may be anatomical, physiological, or psychological. The anatomical aspect refers primarily to the correction of the deviation itself, in other words, the cosmetic deformity. The physiological problem involves the visual acuity and the fusion function. From a psychological viewpoint, a cross-eyed child's personality is affected at a very early age by the social consciousness of his deformity. The cruelty of school children to their contempo-