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An Introduction to Clinical Orbitonometry
867
BOOK REVIEWS
BOOK REVIEWS AN
INTRODUCTION TO CLINICAL
ORBITO-
By A. C. Copper, M.D. Leiden, Stenfert Kroese, 1948. 117 pages, illustrations, diagrams, and bibliography. Price: Clothbound, $3.00; paperbound, $2.25. There has long been a need for a simple instrument, comparable to the tonometer, that would give some degree of accurate estimation of the orbital tension, especially in those conditions that cause an increase in the intraorbital pressure. The clinician in the past has had to be satisfied with the sense of resistance to digital palpation on pushing the eye back into the orbit. Dr. Copper reviews the efforts of scientists to devise an instrument that would give a reliable index of orbital tension. He points out that Langenhan was the first to describe such an apparatus in 1910. Since then, there have been several attempts to improve on the idea and to devise new instruments. Gutmann, in 1914, presented an instrument similar to the Schlitz tonometer, by which he applied increasing amounts of pressure directly on the cornea. He named his apparatus the "piezometer." There were many disadvantages to this instrument and the clinical use of it was disappointing. NOMETRY.
Copper has invented an instrument that may turn out to be of great use to the internist and to the ophthalmologist. By it one can apparently measure the variation of the orbital tension from the normal, and construct curves that yield information as to the character of the lesion behind the eyeball, that is to say whether it is of solid or fluid nature. This should be particularly useful, as the author points out, in helping to decide whether the proptosis is of the thyrotoxic or thyrotropic type, and may be a very important factor in determining whether or not thyroidectomy is indicated. He also presents some evidence that with it one can get some help in determining whether a solid growth is in the temporal
or nasal side of the orbit. Tumors can be diagnosed even in the absence of proptosis. It will not reveal the nature of the new growth, of course. It is only capable of disclosing the presence of abnormal density in the. orbit and of deciding whether the process is stationary or progressive. Copper's instrument consists of a bridge, not unlike that of the Hertel exophthalmometer, resting on each outer orbital rim and the nose. The patient lies down and this bridge is adjusted and held in place by a headband. The eyes are directed forward in the primary position. A plastic contact glass, on the apex of which is fitted a small cylindrical projection, is applied to the cornea. A dynamometer similar in principle to that of Bailliart and calibrated to represent pressures up to 400 gm. is passed through a slit in the bridge, and the plunger of the instrument is lightly inserted into the cup on the apex of the contact glass. The eye is then displaced backward into the orbit by steadily increasing the pressure of the plunger. Various readings up to 400 gm. of pressure are taken and a curve of values is constructed. The author concludes that ( 1 ) Orbitonometry is a valuable diagnostic aid in pathologic intraorbital conditions, and (2) orbitonometry assists in approaching the pathophysiology of certain endocrinal diseases, especially those in which the pituitary and thyroid glands are concerned. The book is well and clearly written. It opens up a field of investigation which is so important that every ophthalmologist should be acquainted with the subject. Derrick Vail. MANUAL
DE
OFTALMOLOGÎA
CLÎNICA
Y
(Manual of Clinical and Theoretical Ophthalmology). By Dr. Manuel Marquez, ex-professor of ophthalmology of the University of Madrid, professor of ophthalmology of the School of Rural Ophthalmology of the National Polytechnic of Mexico. Book 1, General Clinical TEORICA
BOOK REVIEWS
BOOK REVIEWS AN
INTRODUCTION TO CLINICAL
ORBITO-
By A. C. Copper, M.D. Leiden, Stenfert Kroese, 1948. 117 pages, illustrations, diagrams, and bibliography. Price: Clothbound, $3.00; paperbound, $2.25. There has long been a need for a simple instrument, comparable to the tonometer, that would give some degree of accurate estimation of the orbital tension, especially in those conditions that cause an increase in the intraorbital pressure. The clinician in the past has had to be satisfied with the sense of resistance to digital palpation on pushing the eye back into the orbit. Dr. Copper reviews the efforts of scientists to devise an instrument that would give a reliable index of orbital tension. He points out that Langenhan was the first to describe such an apparatus in 1910. Since then, there have been several attempts to improve on the idea and to devise new instruments. Gutmann, in 1914, presented an instrument similar to the Schlitz tonometer, by which he applied increasing amounts of pressure directly on the cornea. He named his apparatus the "piezometer." There were many disadvantages to this instrument and the clinical use of it was disappointing. NOMETRY.
Copper has invented an instrument that may turn out to be of great use to the internist and to the ophthalmologist. By it one can apparently measure the variation of the orbital tension from the normal, and construct curves that yield information as to the character of the lesion behind the eyeball, that is to say whether it is of solid or fluid nature. This should be particularly useful, as the author points out, in helping to decide whether the proptosis is of the thyrotoxic or thyrotropic type, and may be a very important factor in determining whether or not thyroidectomy is indicated. He also presents some evidence that with it one can get some help in determining whether a solid growth is in the temporal
or nasal side of the orbit. Tumors can be diagnosed even in the absence of proptosis. It will not reveal the nature of the new growth, of course. It is only capable of disclosing the presence of abnormal density in the. orbit and of deciding whether the process is stationary or progressive. Copper's instrument consists of a bridge, not unlike that of the Hertel exophthalmometer, resting on each outer orbital rim and the nose. The patient lies down and this bridge is adjusted and held in place by a headband. The eyes are directed forward in the primary position. A plastic contact glass, on the apex of which is fitted a small cylindrical projection, is applied to the cornea. A dynamometer similar in principle to that of Bailliart and calibrated to represent pressures up to 400 gm. is passed through a slit in the bridge, and the plunger of the instrument is lightly inserted into the cup on the apex of the contact glass. The eye is then displaced backward into the orbit by steadily increasing the pressure of the plunger. Various readings up to 400 gm. of pressure are taken and a curve of values is constructed. The author concludes that ( 1 ) Orbitonometry is a valuable diagnostic aid in pathologic intraorbital conditions, and (2) orbitonometry assists in approaching the pathophysiology of certain endocrinal diseases, especially those in which the pituitary and thyroid glands are concerned. The book is well and clearly written. It opens up a field of investigation which is so important that every ophthalmologist should be acquainted with the subject. Derrick Vail. MANUAL
DE
OFTALMOLOGÎA
CLÎNICA
Y
(Manual of Clinical and Theoretical Ophthalmology). By Dr. Manuel Marquez, ex-professor of ophthalmology of the University of Madrid, professor of ophthalmology of the School of Rural Ophthalmology of the National Polytechnic of Mexico. Book 1, General Clinical TEORICA