A Pupil of Picasso

“I’m worried that my son might have a lazy eye.”

Seated in the chair by the exam table, this mother wears a concerned look as she produces a photograph from her purse.  “There—you see what I’m talking about?”

She points to the left eye in her son’s recent school picture.  By a narrow margin, it appears to be slightly smaller than the right one.  I study the color portrait and note that the light from the camera’s flash reflects off each cornea at the exact same spot.

The medical assistant has already checked the boy’s visual acuity on the Snellen chart:  20/20 vision in each eye.

“Anyone with lazy eye in the family?” I ask, reaching for a penlight to peer at the boy’s pupils.  “No?  Anyone in the family ever have eye muscle surgery?”

I ask the boy to follow the light: over, up, across, down, back to center.  I check for lid lag; I perform a cover test.  Finally, I use the ophthalmoscope to peer through the boy’s pupils to study his retinas.

The entire exam is normal.  I expected as much when I first glimpsed the photograph.

I find such encounters gratifying, because I’m able to reassure families that everything is fine purely on the basis of a thorough clinical exam.

“Then why does his one eye look smaller than the other?” his mother asks.

“It has to do with the distribution of the fatty tissue below the surface of the skin around the eyes,” I tell her.  “Have you ever studied Picasso’s works?  If so, you know that Picasso almost never rendered his subjects’ eyes as mirror images of one another.  They are usually of different size, location and proportion in his drawings and paintings.”

The mother seems pleased with my explanations.  She’s also happy that there is nothing wrong with her son’s vision.  All in all, it has turned out to be a good visit—for everyone.

In the Adventure of the Copper Beeches, Sherlock Holmes remarks: “To the man who loves art for its own sake, it is frequently in its least important and lowliest manifestations that the keenest pleasure is to be derived.”

Over the years I have taken keen pleasure in the art of medicine—and in the art of Picasso as well.


One comment on “A Pupil of Picasso

  1. DJE says:

    Agree. They do not all need a referral to an ophthalmologist — they come for reassurance, not just another drug or procedure.You lifted a weight from this mother’s shoulders. That takes time. Btw, the Picasso image you used on the C2S site looked like Apert’s Syndrome. Cheers, D

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