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Cyst of Anterior Chamber
358
NOTES, CASES A N D INSTRUMENTS
E . H., age about 35 years, sustained an injury to the right eye thru the ex plosion of an automobile tire which he was adjusting to the rim. The day following the accident, the upper lid was red and very much swollen. There was considerable injection of the bul bar conjunctiva and a small hemor rhage at the lower, inner portion of the limbus. The pupil was dilated and
at that time. Ophthalmoscopic exam ination of the fundus, which could be clearly seen, now revealed a large rup ture of the choroid, extending from the top of the disc around and down thru the macula. The vision did not im prove from this time and the man was eventually discharged with a practi cally blind eye. 817 Summit Ave.
Fig. 1.—Diagram ot fundus, after clearing of Vossiiis* ring opacity.
the lens hazy. No X-ray pictures were taken as there was no reason to be lieve we had an intraocular foreign body. The fundus details could not be made out because of the haziness of the lens. The vision was fingers at 2 feet. Treatment consisted of atropin and hot fomentations. .Λ. diagnosis was made of Vossius ring cataract, and both the patient and the Indus trial Insurance were advised of a pos sible good prognosis. At the end of a week the capsular haziness seemed to be clearing and at the end of four weeks the lens was practically clear. However, the vision had improved but little, being 20/200
(Hoffman).
CYST OF A N T E R I O R CHAMBER. EVERETT L . CÍOAR. M . D . HOUSTON, TEXAS.
F. C , age 10. In August 1926 the boy was struck in the left eye by a piece of wire, receiving a penetrating wound of the cornea. After several weeks the eye became quiet, l)Ut had very little vision. It has been subject to attacks of irritation since and there has been some pain with considerable lacrimation. A few months ago the mother no ticed one eyeball was larger than the other and it has gradually enlarged since. Vision was reduced to bare light perception. The globe was defi-
S69
NOTES, CASES A N D I N S T R U M E N T S
nitely enlarged and the anterior cham ber was quite deep, more so on the nasal side. Tension was 40 mm. The nasal two-thirds of the anterior cham ber was filled with a semitransparent grayish mass, convex on its outer bor der, displacing the iris backward. Slit lamp examination revealed the wall to be a thin membrane of some sort, but no details could be seen. The eye was enucleated and microscopic sections showed the following interesting con dition : A membrane consisting of several layers of epithelial cells extends from the posterior surface of the cornea, diagonally across the anterior chamber to the anterior surface of the iris, being firmly attached at the pupillary border and along the anterior surface of the iris, rounding the angle of the anterior chamber and back along the posterior surface of the cornea, forming a com plete sac. The iris on that side is very much thinned out. The epithelial membrane is much thicker in the free portion and in the angle of the an terior chamber. It is probably the blocking of this angle that led to the increase in tension. The optic disc shows a very shallow cupping, not at all suggestive of a glaucomatus cup. 1300 Walker Ave. TOXIC AMBLYOPIA FROM DRINKING. GEORGE L . STRADER, M . D . CHEYENNE, WYOMING.
A young man, twenty-four years of age, consulted us with the following history. The day before he began drinking "moonshine" at about 2:30 p. m. He drank about one pint and a half by 11 p. m. At that time he noticed that his vision was failing. Four hours later he was entirely blind. He claimed that he had no special gas tric disturbance. I saw him first at 9:30 a. m. October 10th. His vision was reduced to light perception each eye. There was mod erate congestion of the retinal vessels but not marked. Otherwise, so far as I was able to judge, the fundi were
normal. He complained of supraorbi tal headache. I assumed that the moonshine prob ably contained methyl alcohol. Having seen some reference to treatment of wood alcohol blindness by lumbar puncture I asked Dr. Fox to do a punc ture for me. He found the fluid under considerable pressure and withdrew 40 cc. The morning of October 12th the man could count fingers at J4 foot. That afternoon he was given a pilo carpin sweat which was repeated the following afternoon. Saturday, one week after drinking the alcohol, his vision was R. 20/20; L. with a —0.50 cyl., axis 90°, V . = 20/20. Fields roughly taken, normal for form. No color scotoma. He went home with a letter to his physician advising strychnin and po tassium iodid and we have had no word from him since. I am aware that it is too soon to say that his vision will not ultimately be impaired. It is possible, too, that the moonshine did not contain methyl al cohol. In Ophthalmic Literature, vol. 16, p. 195, reference is made to an arti cle by Zethelius who believes that lumbar puncture surpasses any known method of treatment for Alcoholic Am blyopia. The results were so prompt and so satisfactory in my case that I thought it worthy of a report in the JOURNAL.
Note: Patient seen November 27th, 1926. No change in vision or fundii. F U R R O W KERATITIS OR MAR GINAL DYSTROPHY OF CORNEA. L. L. M C C O Y ,
M.D.
SEATTLE, WASHINGTON.
Mr. J. C , a large, apparently healthy and active laborer, 48 years of age, was first seen January 31, 1925. T w o weeks previously, patient was accidentally struck in left eye with a stick of w o o d ; and since then the eye has been in flamed, slightly painful and discharg ing a small amount of "pus." Patient said he was told ten or twelve years ago by a physician that
NOTES, CASES A N D INSTRUMENTS
E . H., age about 35 years, sustained an injury to the right eye thru the ex plosion of an automobile tire which he was adjusting to the rim. The day following the accident, the upper lid was red and very much swollen. There was considerable injection of the bul bar conjunctiva and a small hemor rhage at the lower, inner portion of the limbus. The pupil was dilated and
at that time. Ophthalmoscopic exam ination of the fundus, which could be clearly seen, now revealed a large rup ture of the choroid, extending from the top of the disc around and down thru the macula. The vision did not im prove from this time and the man was eventually discharged with a practi cally blind eye. 817 Summit Ave.
Fig. 1.—Diagram ot fundus, after clearing of Vossiiis* ring opacity.
the lens hazy. No X-ray pictures were taken as there was no reason to be lieve we had an intraocular foreign body. The fundus details could not be made out because of the haziness of the lens. The vision was fingers at 2 feet. Treatment consisted of atropin and hot fomentations. .Λ. diagnosis was made of Vossius ring cataract, and both the patient and the Indus trial Insurance were advised of a pos sible good prognosis. At the end of a week the capsular haziness seemed to be clearing and at the end of four weeks the lens was practically clear. However, the vision had improved but little, being 20/200
(Hoffman).
CYST OF A N T E R I O R CHAMBER. EVERETT L . CÍOAR. M . D . HOUSTON, TEXAS.
F. C , age 10. In August 1926 the boy was struck in the left eye by a piece of wire, receiving a penetrating wound of the cornea. After several weeks the eye became quiet, l)Ut had very little vision. It has been subject to attacks of irritation since and there has been some pain with considerable lacrimation. A few months ago the mother no ticed one eyeball was larger than the other and it has gradually enlarged since. Vision was reduced to bare light perception. The globe was defi-
S69
NOTES, CASES A N D I N S T R U M E N T S
nitely enlarged and the anterior cham ber was quite deep, more so on the nasal side. Tension was 40 mm. The nasal two-thirds of the anterior cham ber was filled with a semitransparent grayish mass, convex on its outer bor der, displacing the iris backward. Slit lamp examination revealed the wall to be a thin membrane of some sort, but no details could be seen. The eye was enucleated and microscopic sections showed the following interesting con dition : A membrane consisting of several layers of epithelial cells extends from the posterior surface of the cornea, diagonally across the anterior chamber to the anterior surface of the iris, being firmly attached at the pupillary border and along the anterior surface of the iris, rounding the angle of the anterior chamber and back along the posterior surface of the cornea, forming a com plete sac. The iris on that side is very much thinned out. The epithelial membrane is much thicker in the free portion and in the angle of the an terior chamber. It is probably the blocking of this angle that led to the increase in tension. The optic disc shows a very shallow cupping, not at all suggestive of a glaucomatus cup. 1300 Walker Ave. TOXIC AMBLYOPIA FROM DRINKING. GEORGE L . STRADER, M . D . CHEYENNE, WYOMING.
A young man, twenty-four years of age, consulted us with the following history. The day before he began drinking "moonshine" at about 2:30 p. m. He drank about one pint and a half by 11 p. m. At that time he noticed that his vision was failing. Four hours later he was entirely blind. He claimed that he had no special gas tric disturbance. I saw him first at 9:30 a. m. October 10th. His vision was reduced to light perception each eye. There was mod erate congestion of the retinal vessels but not marked. Otherwise, so far as I was able to judge, the fundi were
normal. He complained of supraorbi tal headache. I assumed that the moonshine prob ably contained methyl alcohol. Having seen some reference to treatment of wood alcohol blindness by lumbar puncture I asked Dr. Fox to do a punc ture for me. He found the fluid under considerable pressure and withdrew 40 cc. The morning of October 12th the man could count fingers at J4 foot. That afternoon he was given a pilo carpin sweat which was repeated the following afternoon. Saturday, one week after drinking the alcohol, his vision was R. 20/20; L. with a —0.50 cyl., axis 90°, V . = 20/20. Fields roughly taken, normal for form. No color scotoma. He went home with a letter to his physician advising strychnin and po tassium iodid and we have had no word from him since. I am aware that it is too soon to say that his vision will not ultimately be impaired. It is possible, too, that the moonshine did not contain methyl al cohol. In Ophthalmic Literature, vol. 16, p. 195, reference is made to an arti cle by Zethelius who believes that lumbar puncture surpasses any known method of treatment for Alcoholic Am blyopia. The results were so prompt and so satisfactory in my case that I thought it worthy of a report in the JOURNAL.
Note: Patient seen November 27th, 1926. No change in vision or fundii. F U R R O W KERATITIS OR MAR GINAL DYSTROPHY OF CORNEA. L. L. M C C O Y ,
M.D.
SEATTLE, WASHINGTON.
Mr. J. C , a large, apparently healthy and active laborer, 48 years of age, was first seen January 31, 1925. T w o weeks previously, patient was accidentally struck in left eye with a stick of w o o d ; and since then the eye has been in flamed, slightly painful and discharg ing a small amount of "pus." Patient said he was told ten or twelve years ago by a physician that