1922. No. 4. MIOSIS CONGENITA SEU MICROCORIA FAMILIAR;S. 9 



this is explained as caused by paralysis of the cervical sympathetic nerve; 

 but my patients had no sign of this — the apph'cation of cocaine enlarged 

 the palpebral fissures. For this reason I believed the most natural ex- 

 planation of the lack of dilatator function from birth, to be that the dilatator 

 muscle itself was not developed, or very incompletely so. Prosector 

 O. Berner in the anatomical part given below, will by his fine preparations 

 give the decisive evidence of the truth of this surmise. 



As mentioned before in case a) Ingeborg B.. whose static myopia is 

 of a low degree, a. permanent spasm of accommodatijn is observed to cause 

 a considerable increase of her myopia, even in her 45^11 year. This spasm 

 is accompanied by frontal and occipital headaches, which ahvays disappear 

 after local application of mydriatics on tlie eyes. This patient having never 

 till now suftered from any disease of the central nervous system I believe 

 that this spasm in the ciliary muscle must be considered to be due to a 

 kind of irradiation from m. sphincter pupillae which having no antagonist 

 is always contracted. But the reason why only Miss Ingeborg suffers from 

 spasm of accommodation and not her emmetropic brother Axel and his 

 strongly myopic twin sister Anna, I confess I cannot explain. 



As mentioned above, two of the patients were myopes, one of them 

 to a high degree, the other slighdy, but increasing by spasm of accommo- 

 dation. I do not wish to draw conclusions regarding the origin and deve- 

 lopment of the mN'opia of these two patients; I would, however, empha- 

 size a few facts. 



In case al Ingeborg B., in spite of continuous spasm of accomo- 

 dation since early childJiood, the static myopia ivas very moderate at the 

 age of 21, viz. — 2.75 and — 1.25 D. The diminution of myopia at the 

 age of 43, to — 1.5 and — o-75 Di \vas in my opinion not caused by 

 the mydriatic elimination of the accomodation during 22 years; 1 believe 

 that the static refraction of the lens itself is slightly decreased with age. 

 During those 22 years she has never used convex lenses for close work 

 because she can still easih' read without glasses Snellen 0.5 at a distance 

 of 30 to 50 centimeters. From the age of 21 she has daily installations 

 of mydriatics; before that time she had been obliged to converge strongly 

 daring reading and close work because her myopia, by spasm of accomo- 

 dation, was increased to — 10 or — 12 D. 



In case c) Anna B. I would repeat that the patient never suffered 

 from spasm of accommodatio)), that her m3'opia at the age of 30 years 

 was — 7 and — 8 D, and was increased at the age of 52 to — 15 and 

 — t6 D in spite of daily paralysis of accomodation during 22 years. She 

 could never be persuaded to use strong or weak concave glasses, and did 



