Text-book of ophthalmology . ilt his head, as in this way we may obviate part or all of hisdeviation and diplopia (see page 741).—D.] [659. (1) Restriction of Movement.—This is observed by making theeyes follow an object, e. g. a small white-headed pin, carried successivelyin the six cardinal directions. The paretic eye will lag when it enters thefield of action of the paralyzed muscle and will lag more and more thefurther it is carried into this field. Hence the following table u holdsgood: R. lags Paralysis of Paralysis of Er In R. external rectus R. internal rectus R, superior rectus
Text-book of ophthalmology . ilt his head, as in this way we may obviate part or all of hisdeviation and diplopia (see page 741).—D.] [659. (1) Restriction of Movement.—This is observed by making theeyes follow an object, e. g. a small white-headed pin, carried successivelyin the six cardinal directions. The paretic eye will lag when it enters thefield of action of the paralyzed muscle and will lag more and more thefurther it is carried into this field. Hence the following table u holdsgood: R. lags Paralysis of Paralysis of Er In R. external rectus R. internal rectus R, superior rectus R. inferior oblique R. inferior rectus R. superior Out L. internal rectus. Out In L. external rectus. Eu & R Eu&l Ed & Down Down Up Up Down Down Up L. inferior superior superior oblique. Ed & 1 Up L. inferior rectus. The observation in this manner of the way in which the movement of theparalyzed eye is restricted constitutes the excursion test. But we should. a b [Fig. 325.—Secondary Deviation in Paralysis. (After Posey).A, Paralysis of the left superior rectus with marked upshoot of the right eye, when the gaze isdirected to the left. That the upshoot was due largely to the overaction of the right inferior obliqueis demonstrated in B, which shows how the upshoot disappeared as a result of tenotomy of thismuscle.—D.] also observe the way in which the other eye behaves. For naturally thenon-paralyzed eye follows the object and the other deviates, but when,either because the object is hidden from the non-paralyzed eye by the noseor for other reasons, the paralyzed eye takes up fixation, the paralyzed eyewill be seen to make a sudden extreme movement (secondary deviation,spastic shoot) in the direction in which the eyes are moving. The explana-tion for this has already been given (page 738), namely that the paralyzed [ In this table Er, El, Eu & r, Ed & r, etc., denote when both eyes are directed to the right,left, up and right
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