NOTES, CASES, INSTRUMENTS 119

A CASE FOR DRESSINGS AND EXAMINING EQUIPMENT ■

ALFRED A. NISBET, M.D. San Antonio, Texas

Many of us who do ophthalmic surgery in one or more general hospitals have been confronted with not having dressing material for postoperative care and examination im­mediately available. Frequently after a wait of from five to 15 minutes for a dressing tray to be brought from central supply it is discovered that certain needed articles have been used or borrowed. In order to have items that I considered necessary, it seemed advisable to supply them myself. Their trans­portation then became the main problem.

I tried metal and leather boxes but they proved unsatisfactory. Finally the case illustrated in Figure 1 was adapted for these supplies. Originally it was made for a fish­ing box and is molded of a marbled hard brown plastic which is durable yet light in weight. It is 14.5-inches long, 6.5-inches deep, and 5.5-inches wide. The hinges and fasten­ers are rustless.

Its handle is adequate in size and con­veniently grooved on its under surface. The placement of the handle on the top is such that when the case is closed the contents re­main unmoved while being carried. The edge of the top portion is grooved and the edge of the lower portion is tongued, making a weatherproof closure.

The base portion has two partitions which fit into recesses in the bottom of a pliable plastice ice cube tray and accurately support it. The tray compartments are used to hold drop dispensers and ointment tubes. Behind the tray, plastic lure boxes stand on end and contain small examining equipment, such as an ophthalmoscope head. Beneath the tray in the bottom compartments I have sterile dressing supplies and larger examining equipment.

When in use the case opens widely and the tray may be lifted from the carrying position and placed in the top.

I have used this particular dressing case

Fig. 1 (Nisbet). Case for dressings and examining equipment.

for less than one year but have found it very satisfactory for my needs. It is light in weight, odorless, of adequate size, durable, easily cleaned, weatherproof, and neat in ap­pearance.

700 South McCullough.

A SIMPLE FIXATION LIGHT*

F O R T H E CARDINAL DIRECTIONS OF GAZE

M I L T O N R. R U B I N , M.D. Fresno, California

During the objective examination of the ocular muscle balance, the measurement of the angle of deviation in the six cardinal directions of gaze is of great diagnostic im­portance in the analysis of vertical anomalies. The screen cover test is the best objective method of making these measurements be­cause it gives the most exact revelation of ocular muscle function. However, the test is awkward and unwieldy because the ex­aminer needs one hand for the prisms and one for the screen. Either the patient or an assistant must hold the fixation light. Fur­thermore, in the two downward cardinal positions, it is difficult to see the corneal

* Manufactured by The Head Line Co., Flushing 66, New York.

120 NOTES, CASES, INSTRUMENTS

Fig. 1 (Rubin). Fixation light.

reflexes and eye movements unless the upper lids are elevated by an assistant or by the hand burdened with the prisms.

To overcome some of these difficulties, many ingenious instruments of varying com­plexity and cost have been devised. However, a simple solution to the awkwardness of the test consists of a small fixation light worn on the examiner's forehead. This eliminates the need for an assistant.

In the screen cover test, the closer the axis of observation of the examiner is to the axis of fixation of the patient, the easier and more accurate is the measurement. This is in con­tradistinction to the screen comitance test

where the axis of observation must be differ­ent from the axis of fixation.

When the patient fixes the light on the ex­aminer's forehead, the examiner is looking along an almost identical axis toward the pa­tient's cornea. The head of the patient is sta­tionary, and the examiner's head is moved into each of the six cardinal positions. Thus, even in the two downward cardinal posi­tions, the corneal reflexes and movements are visible without elevation of the upper lids, because of the close approximation of the axis of observation to the axis of fixation.

For some years, I have used an ordinary pen flashlight clipped to a headband for the screen cover test. Recently, there has ap­peared on the market, a small instrument (fig. 1) called the head-penlight* which is even better for the purpose.

The head-penlight consists of a small flash­light in an ingenious plastic case, which can be worn like a pair of glasses. It will also fit above regular glasses with minimal inter­ference. When worn on the head, it has made the screen cover test in the six cardinal posi­tions less awkward and easier to perform. It can also be held in the hand like any light when performing the screen comitance test, in which the axis of observation must be different from the axis of fixation.

2014 Tulare Street.

REFERENCES

Bressler, J. L. : A strabismometer. Tr. Sec. Ophth., A.M.A., 1934, p. 298. Friedenwald, J. S. : Diagnosis and treatment of anisophoria. Arch. Ophth., 15:283, 1936. Krimsky, E. : Cardinal anglometer. Arch. Ophth., 26:670, 1941. Lancaster, W. B. : Detecting, measuring, plotting, and interpreting ocular deviations. Arch. Ophth.,

22 :867, 1939. Montalvan. P. : Duplex rod with handle for routine investigation of extraocular muscles. Arch. Ophth.,

27:1005,1942. Owens, W. C. : A fixation light for the cardinal directions of gaze. Am. J. Ophth., 30:611, 1947. Quereau, J. V., and Putnam, O. A.: Quereau-Putnam Tropophorometer. Arch. Ophth., 33:28, 1945. Smukler, M. E. : Registering deviometer. Arch. Ophth., 22:881, 1939. Sugar, H. S. : An aid in using the prism cover test in the cardinal directions of gaze. Am. J. Ophth.,

28 :397, 1945. White, J. W. : The screen test and its applications. Am. J. Ophth., 19 :653, 1936.