Binocular Vision and Ocular Motility SIXTH EDITION Binocular Vision and Ocular Motility THEORY AND MANAGEMENT OF STRABISMUS Gunter K. von Noorden, MD Emeritus Professor of Ophthalmology Cullen Eye Institute Baylor College of Medicine Houston, Texas Clinical Professor of Ophthalmology University of South Florida College of Medicine Tampa, Florida Emilio C. Campos, MD Professor of Ophthalmology University of Bologna Chief of Ophthalmology S. Orsola-Malpighi Teaching Hospital Bologna, Italy Mosby A Harcourt Health Sciences Company St. Louis London Philadelphia Sydney Toronto Mosby A Harcourt Health Sciences Company Editor-in-Chief: Richard Lampert Acquisitions Editor: Kimberley Cox Developmental Editor: Danielle Burke Project Manager: Agnes Byrne Production Manager: Peter Faber Illustration Specialist: Lisa Lambert Book Designer: Ellen Zanolle Copyright ᭧ 2002, 1996, 1990, 1985, 1980, 1974 by Mosby, Inc. All rights reserved. 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Library of Congress Cataloging-in-Publication Data Von Noorden, Gunter K., 1928– Binocular vision and ocular motility : theory and management of strabismus / Gun- ter K. von Noorden, Emilio C. Campos.—6th ed. p. cm. Includes bibliographical references and index. ISBN 0–323–01129–2 1. Strabismus. 2. Binocular vision. 3. Eye—Movements. I. Title. RE771.V62 2001 616.7Ј62—dc21 2001042586 0102030405/987654321 HERMANN MARTIN BURIAN 1906-1974 Preface to the Sixth Edition major change with this edition is the addition The formerly voluminous chapter on sensory Aof co-author Dr. Emilio Campos, who is one adaptation and stereopsis has been divided into of the leaders of European strabismology and three smaller chapters for easier access. Because widely respected for his scientific contributions. sensorial anomalies in strabismus are only briefly Dr. Campos has written a new chapter on Chemo- dealt with in current texts, or receive at best spuri- denervation and assisted me with the review and ous coverage in most teaching curricula for resi- revision of this sixth edition. I selected Dr. dents, the comprehensive discussion of this sub- Campos as a co-author because his scientific back- ject in this book appears to be fully justified. ground is similar to mine. His mentor Bruno Bag- The contributions and teaching of Hermann Bu- olini was trained, as I was, by the late Hermann rian remain apparent throughout this text but espe- Burian, with whom I co-authored the first edition. cially in Part One. We submit this volume not Because of this common heritage we agree on all only as his legacy but also that of his teacher, major issues discussed in this text. Whenever an Alfred Bielschowsky, who has influenced strabis- mology during the first half of the 20th century occasional difference in opinions existed on minor like no one else. subject matters both of our views were stated. My thanks are due to Mrs. Louise Thomas, my As in previous editions, new material was added faithful former secretary, for obtaining copies of and older text that had lost its relevance was articles from the local medical libraries and illus- deleted, except when it was of historical interest. trations through the Baylor Department of Medical Binocular Vision and Ocular Motility has become Illustrations, and to Mr. Mike Piorunski, librarian a major source of references to the older strabis- of the Friedenwald Library of the Wilmer Institute, mus literature that is not retrievable through elec- for locating and verifying older references. Last, tronic search techniques. With this in mind, we but not least, I thank my dear wife for her contin- have used a conservative approach in deleting ued support and patience during the work on this older references so that they would remain avail- edition. able to the researcher and interested clinician. The authors have no proprietary interest in any We have endeavored to improve clarity in the of the commercial products, drugs, or instruments text and tables, replaced several old figures with mentioned in this book. better examples, and added illustration of surgical techniques not covered in previous editions. Gunter K. von Noorden feel deeply honored for having been asked by tino Bellusci, who have helped me in the prepara- IDr. Gunter von Noorden to collaborate with tion of clinical illustrations and surgical drawings. him on the sixth edition of Binocular Vision and Many thanks also to Stefania Piaggi, C.O., for Ocular Motility, and I consider this recognition as having located obscure references and for her help one of the highlights of my career. with the computer search of the literature. I hope that my input to this edition has not I am grateful to all my collaborators and to interfered with the homogeneity of this book and those close to me for their patience during the its original message. preparation of the manuscript and ask their for- Both Dr. von Noorden and I would appreciate giveness for any lack of attention during this most any input from our readers that may help us to stimulating but time-consuming venture. make future editions even more useful. I would like to express my gratitude to my collaborators Drs. Costantino Schiavi and Costan- Emilio C. Campos Preface to the First Edition He who is theoretic as well as practical is possible, always with the practicing ophthalmolo- therefore doubly armed: able not only to prove gist in mind and wherever possible emphasizing the propriety of his design but equally so to its immediate clinical application. But much has carry it into execution. happened in our field since the days of the old VITRUVIUS masters, and due consideration is given to the exciting and significant modern studies in the psy- chophysical and neurophysiologic areas as well as his volume is the product of the cooperative in the field of clinical management of strabismus. Tefforts of the two authors. Parts I and II were This volume is not a handbook or a system, how- written by Burian, and Parts III and IV by von ever, and is not intended to be systematically or Noorden; however, both authors take full responsi- historically complete. We, therefore, have omitted bility for the complete text. many points that are to be found in reference In this work, our aim is to provide the practic- works. Neither does this book supplant the Atlas ing ophthalmologist as well as the budding one of Strabismus by von Noorden and Maumenee, with the theoretic knowledge and practical know- which continues to be a useful guide to the diag- how that will enable him to pursue the field of nostic aspects of strabismus. neuromuscular anomalies of the eyes in the man- The theoretic foundation has served us as a ner set forth in the precept of Vitruvius. means to make the strictly clinical chapters both The sound physiologic tradition of Hering, ‘‘theoretic and practical,’’ telling the ophthalmolo- Helmholtz, Donders, Tschermak, Hofmann, and gist not only the ‘‘what and how’’ but also the ‘‘why.’’ We hope that the long hours of labor their schools forms the solid ground upon which expended on this volume may be of real use- was built the clinical work of Javal, Worth, fulness in the study of strabismus, particularly to Bielschowsky, Duane, Lancaster, and, more re- the younger generation of ophthalmologists. cently, Harms, Cu¨ppers, Lyle, Bagolini, ourselves, and many others. Our purpose has been to convey Hermann M. Burian this physiologic basis as concisely and simply as Gunter K. von Noorden Contents PART ONE Monocular (Nonstereoscopic) Clues to Spatial Orientation 25 Physiology of the Sensorimotor Interaction of Stereoscopic and Monocular Clues 27 Cooperation of the Eyes Clinical Significance of Monocular Clues 27 Experimental Determination of the Longitudinal Horopter and the Criteria of Retinal 1 General Introduction .................. 3 Correspondence 28 Criterion of Single Vision 28 The Eyes as a Sensorimotor Unit 3 Apparent Frontal Plane Criterion 28 The Tasks of the Motor System 3 Criterion of Common Visual Directions 29 Nature and Control of Ocular Movements 3 Criterion of Highest Stereoscopic Sensitivity 29 Voluntary and Involuntary Eye Movements 3 Egocentric (Absolute) Localization 29 Cybernetic Control of the Eye Movements 4 Egocentric Localization and Convergence 29 Apparent Movement of the Environment 5 Egocentric Localization and Proprioception 30 Empiricism and Nativism 5 Clinical Significance of Relative and Egocentric Localization 31 Theories of Binocular Vision 31 2 Binocular Vision and Space Correspondence and Disparity 31 Perception .............................