1502 N O T E S , CASES, I N S T R U M E N T S

Fig. 1 (Bedrossian). A small self-retaining re­tractor for use in examining the eyes of premature infants.

is extremely difficult and frequently unsatis­factory. Holding the eyes open with the fingers is not satisfactory because the lids often slip or evert. The end result is a scratched cornea and a disgusted examiner. The hand retractors, which are also some­times used, traumatize the lids if the infant moves suddenly.

A small self-retaining retractor* (figs. 1 and 2) has been designed for use in small infants and prematures and is now being used at the Philadelphia General Hospital with excellent results. The retractor has small, curved, solid blades which eliminate any sharp edges and keep the lids from bulg­ing through any openings. The small screw-

lock permits the adjustment of the blades to the proper width without the excessive pres­sure that may occur with a strong spring.

Twenty eyes have been stained with fluo-rescein following the insertion of this instru­ment, and in no case were any abrasions of the cornea seen with the loupe. No lid trauma has been observed as a result of us­ing the retractor.

Following use, the speculum is wiped with a solution of metaphen and, to date, no in­fections have occurred. No anesthesia has been necessary and the infant may move its head without the retractor coming out or the lids being traumatized.

The use of this instrument has cut down the examination time of the infants and, above all, the fundus can be studied rather than just being seen with a quick glance.

4501 State Road.

Fig. 2 (Bedrossian). Another view of the retractor.

* Manufactured by George Pilling & Son, Phila­delphia.

T H E EYE EXERCISE STICK

M. L. STECKLER, M.D. Los Angeles, California

Patients will not use their fingers or a dot on a piece of paper as an orthoptic target when they do their home eye exercises. This procedure is too simple or too insignificant for the patient to have much faith in its use­fulness, and there is a lack of interest because the procedure is monotonous.

The eye exercise stick (fig. 1*) has been devised for such conditions as convergence insufficiency, fusion deficiency, fusion-con­vergence insufficiency, inertia of accommoda­tion, phorias, and so forth, but especially for fusion-convergence insufficiency. The eye exercise stick definitely holds the patient's interest for eight weeks and does get excel­lent results.

TECHNIQUE

The technique is simple and requires but a moment three times a day. The patient

* Manufactured by Wermil Company, 8560 Venice Boulevard, Los Angeles 34.

NOTES, CASES, INSTRUMENTS 1503

carries the stick in his pocket or purse. For wearers of single-vision lenses or no

lenses, the eye exercise stick is held at arm's length and on a level with the eyes, the patient concentrating on the large E . Slowly drawing it toward his eyes, constantly making an effort to keep it clear, he comes to a point at which it blurrs or he can't keep it clear any longer, than he pushes the stick back to arm's length, where it. again is clearly seen, and be­gins over again. This he does five times, three times a day for two weeks.

At the end of the first two weeks, he concentrates on the middle-sized E on the stick, and repeats the same procedure, 10 times, three times a day for an­other two weeks.

At the end of the second two weeks, he moves up to the small­est E on the eye exercise stick, and repeats the same procedure 15 times three times a day for another two weeks.

At the end of the third two weeks, if the patient's vision is sufficiently improved, and if, in the opinion of the ophthalmolo­gist, the exercises should be con­tinued, the patient concentrates on the upper small vertical line (Duane line) and repeats the

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Fig. 1 (Steckler).

The eye ex­ercise stick.

same procedure as described, 20 times, three times a day for the last two weeks.

Of course these procedures require less time than it takes to read the directions for them.

For bifocal wearers, the eye exercise stick, when held at arm's length and on a level with the eyes (patient is looking through his dis­tance lenses), is usually blurred, so the stick is held downward in front of the eyes so that the patient is looking through the bifocal segments while doing the same maneuvers as outlined for wearers of single-vision lenses above.

DISCUSSION Many patients with the various muscle im­

balances present no symptoms unless under mental or physical stress or strain, or after some acute or chronic malady lowers the gen­eral resistance, disturbs the metabolism or endocrine balance.

When symptoms appear, such a patient can immediately resort to his eye exercise stick for another eight weeks or until his symptoms disappear. The orthofusor or prism exercises at home are not practical to treat these imbalances for they are too ex­pensive, time consuming, and do not inter­est the patient enough to assure good or­thoptic results.

The eye exercise stick is insignificant in price and its use is interesting. It is a valuable supplement to formal office orthoptics be­cause it is used three times daily and thus insures continuous orthoptic training.

2007 Wilshire Boulevard (5).

OPHTHALMIC MINIATURE

Cleanliness is not sufficiently attended to ; three sponges are not enough for a ward containing nearly one hundred patients; there should be at least a dozen sponges, and the elder children should be shown how to use them themselves, and compelled to do so several times a day.

W. R. Wilde, London Journal of Medicine, 1851.