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Bacteriology of Traumatic Corneal Ulcers*
89
BACILLUS PROTEUS ENDOPHTHALMITIS While it is seldom possible to demonstrate the causative organism during the course of a postoperative panophthalmitis, one must always consider the possibility of one of the gram-negative bacilli as the etiologic agent. Because of the potential danger of Bacillus proteus, and its frequent occurrence in the conjunctival sacs of older people, Gantrisin could well be added to the therapeutic regi men in the treatment of intraocular infec tions. SUMMARY
1. Therapeutic levels of Gantrisin were obtained in the aqueous by all methods of ad ministration. 2. Over 70 percent of strains of B.
proteus were inhibited by concentrations of Gantrisin which are reached in the aqueous by the usual methods of administration. 3. Only 40 percent of strains of B. proteus were inhibited by concentrations of neomycin which were obtained in the aqueous. 4. Chloramphenicol and tetracycline did not inhibit B. proteus in concentrations which could be obtained in the aqueous by the usual methods of administration and in the usual dosage, using rabbits. 5. Eighty percent of strains of B. proteus were found sensitive to a concentration of 20 [J.g./cc. of chloramphenicol, a level re ported possible to obtain. University
of Toronto
(5).
REFERENCES
1. Callaghan, A.: Effect of sulfonamides and antibiotics on panophthalmitis complicating cataract ex traction. Arch. Ophth, 49:212: 1953. 2. Maylath, F. R., and Leopold, I. H.: Experimental intraocular infection. Am. J. Ophth., 40:86-101 (July) 19SS. 3. Cowan, R. F.: Unpublished data, 1953. 4. Britton, A., and Marshall, E.: New coupling component for sulfonamide determination. J. Biol. Chem., 128 :537, 1939. 5. MacLeod, C.: A medium for testing bacterial sensitivity of sulfonamides. J. Exper. Med., 72:217, 1940. 6. Witzel, S. H., Fielding, I. L., and Ormsby H. L.: Ocular penetration of antibiotics by iontophoresis. Am. J. Ophth., 42:89 (Oct. Pt. II) 1956. 7. Abraham, R. K., and Burnett, H. H.: Tetracycline and chloramphenicol studies on rabbit and human eyes. Arch. Ophth., 54 :641, 1955. BACTERIOLOGY OF TRAUMATIC CORNEAL ULCERS* STELLA EADIE, F.R.C.S.
(EDINBURGH)
Edinburgh, Scotland Although much work has been carried out on the bacteriology of corneal ulcers, little has been written on the relationship between the bacteriologic picture and the clinical course of the condition. This study of traumatic ulcers of the cor nea admitted to the Royal Infirmary, Edin burgh, during the years 1952 and 1953 was, therefore, undertaken to t r y to correlate the clinical picture with the bacteriologic find ings. The ulcers were treated with either sodium sulfacetamide or terramycin to com* From the Department of Ophthalmology, Royal Infirmary.
pare the relative value of one of the sulfonamides with one of the wide spectrum antibiotics. The findings arising out of this series were then analyzed in order to de termine the relationship between the bac teriology, the occupation, the preadmission treatment, and the prognosis. CLINICAL
MATERIAL A N D F I N D I N G S
This series consists of 40 cases of trau matic corneal ulcers admitted to the Royal Infirmary, Edinburgh, during the period 1952-1953. On admission all cases had a culture taken from the conjunctival sac of
00
S T E L L A EADTE
the affected side and also from the corneal ulcer. The material was inoculated directly onto culture 'material. The ulcers were rubbed with terramycin or sulfacetamide powder on admission, and then were given either 0.5-percent terramycin or 15-percent sodium sulfacetamide drops, three hourly. Four cases had chronic dacryocystitis: in three of these a dacryocystorhinostomy was performed within 48 hours of admission; the topical treatment continued as in the other cases. Alternate cases were treated with terramycin and sodium sulfacetamide. No significant difference was found in the results of the two methods of treatment. The average stay in hospital of all cases treated with sulfacetamide was 14 days against 16 days for those treated with terra mycin. On discharge, 10 cases in each group had 6/12 or better vision. The pathogenic organisms which were cultured were Micrococcus pyogenes var. aureus—seven cases ; Diplococcus pneumoniae—10 cases; and from one case, Alcaligenes faecalis was isolated. The average stay in hospital of those cases growing Mi crococcus pyogenes var. aureus was 23 days, and of those growing Diplococcus pneumoniae, 22 days. The type of pathogenic organism was therefore not important in the clinical course of the disease. It appeared, however, that irrespective of the drug used a significant difference was noted in the clinical course of those cases which grew pathogenic organisms either from the conjunctival sac or from the ulcer, and those which had no growth or only grew the normal commensal organisms of the conjunctiva—Micrococcus pyogenes var. albus or diphtheroid organism. The stay in
hospital of those growing pathogenic organ isms was more than twice as long as those without, and the visual results were worse (table 1). An attempt was made to differentiate be tween these two groups in regard to the oc cupation of the patient and the preadmission state and treatment. INFLUENCE OF OCCUPATION
This series includes 28 underground workers and 12 nonminers. Pathogenic or ganisms were found in all the nonminers but in less than a quarter of the miners (six cases) : while cultures from the remaining 22 miners either grew commensals or failed to grow any organisms. The four cases of dacryocystitis were divided equally between the two groups. The clinical course in these groups showed the same trend as the whole series (table 2) although the miners with patho genic organisms fared better than the nonminers. INFLUENCE OF PREADMISSION TREATMENT
Where necessary, letters were sent to the patients' general practitioners and the firstaid post at the colliery, to ascertain in detail the preadmission treatment. Excepting the four patients who were suf fering from chronic dacryocystitis and who were therefore unlikely to benefit from simple topical therapy only, 36 cases remain. In these cases it was noted that attendance at the first-aid post where sulfacetamide was instilled soon after the injury did not in fluence the presence or absence of patho gens, but half the patients, both miners and nonminers, who grew pathogenic organ-
TABLE 1 INFLUENCE ON STAY IN THE HOSPITAL
Those growing pathogens Those not growing pathogens
Total
Stay in Hospital (days)
Vision 6/12 or Better
18 22
22 9
7 13
Vision Worse than 6/12 10 + 1 with tobacco amblyopia 8 + 1 not known
TRAUMATIC
CORNEAL
ULCERS
TABLE 2 INFLUENCE OF OCCUPATION
Total
Stay in Hospital (days)
Vision 6/12 or Better
Vision Worse than 6/12
22 6 12
9 17 23
13 3 4
8 + 1 unknown 2 + 1 with tobacco amblyopia 8
Miners not growing pathogens Miners growing pathogens Nonminers growing pathogens
TABLE 3
TABLE 5
INFLUENCE OF PREADMISSION TREATMENT
INCIDENCE OF HYPOPYON
Topical Therapy
Number of Cases
Sulface- Other Number tamide Drops of a t First- and Cases Aid Lotions Post Miners with pathogenic organisms Miners without patho genic organisms Nonminers with patho genic organisms
4
3
3
22
12
1
10
—
4
Miners without patho gens Miners with pathogens Nonminers with patho gens
Days Number Before with Admis Hypo sion pyon
24 6
4 3
1 2
12
4
8
DISCUSSION
isms had instilled drops other than sulfacetamide or antibiotics—usually either cas tor oil or boric lotion—whereas, only one miner in the group who failed to grow pathogens had instilled castor oil (table 3). It was found that all patients without pathogenic organisms attended their own doctor and started topical therapy slightly earlier than those with pathogens (table 4 ) . The interval of time between injury and ad mission was the same for miners without pathogenic organisms and nonminers, but slightly less for miners with pathogenic or ganisms. As would be expected, those with pathogens had the highest incidence of hypo pyon (table 5).
From these results it is seen that trau matic corneal ulcers which grow pathogenic organisms are found less often in miners than in other members of the community, and this, associated with earlier initial treat ment, accounts for the better prognosis of traumatic corneal ulcers in miners than in other members of the community—a fact which was pointed out by Scott (1954). In order to extend the findings in this paper the results in 119 cases of traumatic corneal ulcer admitted to Wards 41 and 42 of the Royal Infirmary, Edinburgh, during the period 1950-1953. were analyzed and it was seen that the same trend is found (table 6). The only other worker who has correlated
TABLE 4 TOPICAL THERAPY AT HOME
Number of Cases Miners without pathogens Miners with pathogens Nonminers with pathogens
22 4 10
Interval Before Starting Treatment Less than 2 Days 10 1 3
2 Days or Longer
None
Unknown
STELLA EADIE
92
TABLE 6 RESULTS IN 119 CASES OF TRAUMATIC CORNEAL ULCER
Miners with pathogenic organisms Miners without pathogenic organisms Nonminers with pathogenic organisms Nonminers without pathogenic organisms
Number of Cases
Stay in Hospital (days)
Vision 6/12 or Better
23
IS
12
8
3
65
10
42
18
5
22
20
8
10
4
9
17
5
4
the bacteriologic finding with the patient's occupation was Rhodes ( 1 9 4 0 ) . H e failed to find that there was any significant differ ence in the cultures from the different groups of the community. But he does state that negative cultures occurred more often in injuries from coal (28 percent negative) than in injuries from stone (four percent negative). The failure to grow pathogenic organisms either from the ulcer or from the conjunc tiva may be due to two factors. Firstly, the ulcer could be due to chemical injury of a type similar to that described by Stevenson (1927). This is unlikely or it would be more closely associated with foreign bodies. Sec ondly, the failure of growth could be due to the fact that the infection had already been partially overcome by the initial treatment so that the remaining organisms were so few and nonvirulent that they failed to grow on culture, in spite of careful technique. This would be most likely to occur when the treatment was started early and where the inoculation of the organisms was not deep in the cornea. In nonminers the injury is usually caused by septic material—stone off the road, a thorn, and a cat's claw were three examples in this series. In these cases, the infection is primary and the organisms are inoculated deeply into the cornea. I n miners, most of the injuries occur at the coal-face. T h i s coal is practically sterile (Rhodes, 1941) and therefore infection must be secondary. This secondary infection may be either
Vision than 6/12
\\ orse
Unknown
endogenous or exogenous. Endogenous in fection may come from either the conjunc tiva or from the lacrimal sac. Conjunctival infection is not likely to be severe and should respond quickly to sulfacetamide or antibiotic therapy as the body already has specific antibodies to the organism. Exoge nous infection may come from many sources: the patient's handkerchief, the first-aid attendant's hands, instruments or even the tongue, and finally from the ma terial instilled into the eye. It can be seen, therefore, that first-aid plays a vital part in the treatment and prevention of corneal ulcers, and that inefficient or septic first-aid may do more h a r m than good. F u r t h e r improvement in the prevention and treatment of traumatic corneal ulcers therefore depends on cleanliness in the handling of eye injuries, on the early use of sulfacetamide or antibiotics either at the first-aid post or from the patient's own gen eral practitioner, and finally on the appreci ation of the need for greater vigilance in those injuries where the infection is pri mary. SUMMARY
1. There was no significant difference in the results of traumatic corneal ulcers treated topically with sulfacetamide and terramycin. 2. Traumatic corneal ulcers in miners have a better prognosis than traumatic cor neal ulcers in nonminers. 3. Pathogenic organisms can be cultured
93
TRAUMATIC CORNEAL ULCERS less often from corneal ulcers of miners than from corneal ulcers in nonminers. The reasons for this are discussed. 4. The importance of the preadmission treatment on the ultimate course of the ulcer is stressed. The Royal Infirmary
(3).
ACKNOWLEDGMENTS
I wish to thank Prof. G. I. Scott for permission to publish these cases and for his advice and co operation : also Dr. T. B. M. Durie of the bac teriology department for his help in the bacteriologic aspects of this paper. I have been in receipt of a grant from the W. H. Ross Foundation (Scotland) for the Prevention of Blindness. The terramycin was kindly supplied by Pfizer, Limited.
REFERENCES
Rhodes, A. J.: Studies on the etiology of hypopyon ulcer of the cornea (1941). M.D. Thesis Univer sity of Edinburgh. : Brit. J. Ophth., 23 :637, 1940. Stevenson, E.: Tr. Ophth. Soc. U. Kingdom, 47 :5S, 1927. Scott, G. I.: Tr. Ophth. Soc. U. Kingdom, 74:105, 1954.
T H R O M B I IN T H E CILIARY V E I N S O F E Y E S F R O M N E W B O R N I N F A N T S * V O L C K H E R D T M.
DE GROOT,
M.D.
Detroit, Michigan AND J O N A S S.
FRIEDENWALD,
M.D.
Baltimore, Maryland It is the purpose of this paper to present 10 cases of thrombi in the ciliary veins of newborn infants. A s far as we are aware there is no description of this phenomenon in the literature, either as an isolated finding or in connection with other intraocular dis ease. W e recognized the first case in March, 1953, in the eyes of a Negro newborn child who died in December, 1952. O u t of 75 pairs of eyes from infants who were still born or who died shortly after birth, ex amined in the W i l m e r eye pathology labora tory from March 1, 1953, until March 1, 1954, we collected a total of eight such cases, an incidence of more than 10 percent during that year. * From the Department of Ophthalmology of the Henry Ford Hospital, and the Wilmer Ophthalmological Institute of The Johns Hopkins Uni versity School of Medicine and Hospital. Based on a study carried out in the Wilmer Institute during 1953 and 19S4 and presented in large part before the Wilmer Residents Meeting on April 2, 1954.
Prior to March 1, 1953, the lesion had not been recognized by us. W e therefore reviewed all the slides from newborn and fetal eyes acquired by the W i l m e r eye path ology laboratory prior to March 1, 1953. Over 200 such cases were reviewed, but only two more instances of thrombi in the ciliary veins were found in acquisitions from the years 1935 to 1953. These two had appeared between 1950 and 1953. N o cases were rec ognized in eyes obtained prior to 1950. PATHOLOGIC STUDY OF T H E 10
CASES
W I T H THROMBI A.
OCULAR
FINDINGS
All thrombi appear to have been fresh (figs, l a and l b ) . A rough estimation sug gests they were only a few hours old. Only parts of the ciliary veins are involved, with out any particular location in the ciliary body. Some are in the pars plana, others in the processes. O n e case shows fine retinal hemorrhages, but all nine of the other cases
BACILLUS PROTEUS ENDOPHTHALMITIS While it is seldom possible to demonstrate the causative organism during the course of a postoperative panophthalmitis, one must always consider the possibility of one of the gram-negative bacilli as the etiologic agent. Because of the potential danger of Bacillus proteus, and its frequent occurrence in the conjunctival sacs of older people, Gantrisin could well be added to the therapeutic regi men in the treatment of intraocular infec tions. SUMMARY
1. Therapeutic levels of Gantrisin were obtained in the aqueous by all methods of ad ministration. 2. Over 70 percent of strains of B.
proteus were inhibited by concentrations of Gantrisin which are reached in the aqueous by the usual methods of administration. 3. Only 40 percent of strains of B. proteus were inhibited by concentrations of neomycin which were obtained in the aqueous. 4. Chloramphenicol and tetracycline did not inhibit B. proteus in concentrations which could be obtained in the aqueous by the usual methods of administration and in the usual dosage, using rabbits. 5. Eighty percent of strains of B. proteus were found sensitive to a concentration of 20 [J.g./cc. of chloramphenicol, a level re ported possible to obtain. University
of Toronto
(5).
REFERENCES
1. Callaghan, A.: Effect of sulfonamides and antibiotics on panophthalmitis complicating cataract ex traction. Arch. Ophth, 49:212: 1953. 2. Maylath, F. R., and Leopold, I. H.: Experimental intraocular infection. Am. J. Ophth., 40:86-101 (July) 19SS. 3. Cowan, R. F.: Unpublished data, 1953. 4. Britton, A., and Marshall, E.: New coupling component for sulfonamide determination. J. Biol. Chem., 128 :537, 1939. 5. MacLeod, C.: A medium for testing bacterial sensitivity of sulfonamides. J. Exper. Med., 72:217, 1940. 6. Witzel, S. H., Fielding, I. L., and Ormsby H. L.: Ocular penetration of antibiotics by iontophoresis. Am. J. Ophth., 42:89 (Oct. Pt. II) 1956. 7. Abraham, R. K., and Burnett, H. H.: Tetracycline and chloramphenicol studies on rabbit and human eyes. Arch. Ophth., 54 :641, 1955. BACTERIOLOGY OF TRAUMATIC CORNEAL ULCERS* STELLA EADIE, F.R.C.S.
(EDINBURGH)
Edinburgh, Scotland Although much work has been carried out on the bacteriology of corneal ulcers, little has been written on the relationship between the bacteriologic picture and the clinical course of the condition. This study of traumatic ulcers of the cor nea admitted to the Royal Infirmary, Edin burgh, during the years 1952 and 1953 was, therefore, undertaken to t r y to correlate the clinical picture with the bacteriologic find ings. The ulcers were treated with either sodium sulfacetamide or terramycin to com* From the Department of Ophthalmology, Royal Infirmary.
pare the relative value of one of the sulfonamides with one of the wide spectrum antibiotics. The findings arising out of this series were then analyzed in order to de termine the relationship between the bac teriology, the occupation, the preadmission treatment, and the prognosis. CLINICAL
MATERIAL A N D F I N D I N G S
This series consists of 40 cases of trau matic corneal ulcers admitted to the Royal Infirmary, Edinburgh, during the period 1952-1953. On admission all cases had a culture taken from the conjunctival sac of
00
S T E L L A EADTE
the affected side and also from the corneal ulcer. The material was inoculated directly onto culture 'material. The ulcers were rubbed with terramycin or sulfacetamide powder on admission, and then were given either 0.5-percent terramycin or 15-percent sodium sulfacetamide drops, three hourly. Four cases had chronic dacryocystitis: in three of these a dacryocystorhinostomy was performed within 48 hours of admission; the topical treatment continued as in the other cases. Alternate cases were treated with terramycin and sodium sulfacetamide. No significant difference was found in the results of the two methods of treatment. The average stay in hospital of all cases treated with sulfacetamide was 14 days against 16 days for those treated with terra mycin. On discharge, 10 cases in each group had 6/12 or better vision. The pathogenic organisms which were cultured were Micrococcus pyogenes var. aureus—seven cases ; Diplococcus pneumoniae—10 cases; and from one case, Alcaligenes faecalis was isolated. The average stay in hospital of those cases growing Mi crococcus pyogenes var. aureus was 23 days, and of those growing Diplococcus pneumoniae, 22 days. The type of pathogenic organism was therefore not important in the clinical course of the disease. It appeared, however, that irrespective of the drug used a significant difference was noted in the clinical course of those cases which grew pathogenic organisms either from the conjunctival sac or from the ulcer, and those which had no growth or only grew the normal commensal organisms of the conjunctiva—Micrococcus pyogenes var. albus or diphtheroid organism. The stay in
hospital of those growing pathogenic organ isms was more than twice as long as those without, and the visual results were worse (table 1). An attempt was made to differentiate be tween these two groups in regard to the oc cupation of the patient and the preadmission state and treatment. INFLUENCE OF OCCUPATION
This series includes 28 underground workers and 12 nonminers. Pathogenic or ganisms were found in all the nonminers but in less than a quarter of the miners (six cases) : while cultures from the remaining 22 miners either grew commensals or failed to grow any organisms. The four cases of dacryocystitis were divided equally between the two groups. The clinical course in these groups showed the same trend as the whole series (table 2) although the miners with patho genic organisms fared better than the nonminers. INFLUENCE OF PREADMISSION TREATMENT
Where necessary, letters were sent to the patients' general practitioners and the firstaid post at the colliery, to ascertain in detail the preadmission treatment. Excepting the four patients who were suf fering from chronic dacryocystitis and who were therefore unlikely to benefit from simple topical therapy only, 36 cases remain. In these cases it was noted that attendance at the first-aid post where sulfacetamide was instilled soon after the injury did not in fluence the presence or absence of patho gens, but half the patients, both miners and nonminers, who grew pathogenic organ-
TABLE 1 INFLUENCE ON STAY IN THE HOSPITAL
Those growing pathogens Those not growing pathogens
Total
Stay in Hospital (days)
Vision 6/12 or Better
18 22
22 9
7 13
Vision Worse than 6/12 10 + 1 with tobacco amblyopia 8 + 1 not known
TRAUMATIC
CORNEAL
ULCERS
TABLE 2 INFLUENCE OF OCCUPATION
Total
Stay in Hospital (days)
Vision 6/12 or Better
Vision Worse than 6/12
22 6 12
9 17 23
13 3 4
8 + 1 unknown 2 + 1 with tobacco amblyopia 8
Miners not growing pathogens Miners growing pathogens Nonminers growing pathogens
TABLE 3
TABLE 5
INFLUENCE OF PREADMISSION TREATMENT
INCIDENCE OF HYPOPYON
Topical Therapy
Number of Cases
Sulface- Other Number tamide Drops of a t First- and Cases Aid Lotions Post Miners with pathogenic organisms Miners without patho genic organisms Nonminers with patho genic organisms
4
3
3
22
12
1
10
—
4
Miners without patho gens Miners with pathogens Nonminers with patho gens
Days Number Before with Admis Hypo sion pyon
24 6
4 3
1 2
12
4
8
DISCUSSION
isms had instilled drops other than sulfacetamide or antibiotics—usually either cas tor oil or boric lotion—whereas, only one miner in the group who failed to grow pathogens had instilled castor oil (table 3). It was found that all patients without pathogenic organisms attended their own doctor and started topical therapy slightly earlier than those with pathogens (table 4 ) . The interval of time between injury and ad mission was the same for miners without pathogenic organisms and nonminers, but slightly less for miners with pathogenic or ganisms. As would be expected, those with pathogens had the highest incidence of hypo pyon (table 5).
From these results it is seen that trau matic corneal ulcers which grow pathogenic organisms are found less often in miners than in other members of the community, and this, associated with earlier initial treat ment, accounts for the better prognosis of traumatic corneal ulcers in miners than in other members of the community—a fact which was pointed out by Scott (1954). In order to extend the findings in this paper the results in 119 cases of traumatic corneal ulcer admitted to Wards 41 and 42 of the Royal Infirmary, Edinburgh, during the period 1950-1953. were analyzed and it was seen that the same trend is found (table 6). The only other worker who has correlated
TABLE 4 TOPICAL THERAPY AT HOME
Number of Cases Miners without pathogens Miners with pathogens Nonminers with pathogens
22 4 10
Interval Before Starting Treatment Less than 2 Days 10 1 3
2 Days or Longer
None
Unknown
STELLA EADIE
92
TABLE 6 RESULTS IN 119 CASES OF TRAUMATIC CORNEAL ULCER
Miners with pathogenic organisms Miners without pathogenic organisms Nonminers with pathogenic organisms Nonminers without pathogenic organisms
Number of Cases
Stay in Hospital (days)
Vision 6/12 or Better
23
IS
12
8
3
65
10
42
18
5
22
20
8
10
4
9
17
5
4
the bacteriologic finding with the patient's occupation was Rhodes ( 1 9 4 0 ) . H e failed to find that there was any significant differ ence in the cultures from the different groups of the community. But he does state that negative cultures occurred more often in injuries from coal (28 percent negative) than in injuries from stone (four percent negative). The failure to grow pathogenic organisms either from the ulcer or from the conjunc tiva may be due to two factors. Firstly, the ulcer could be due to chemical injury of a type similar to that described by Stevenson (1927). This is unlikely or it would be more closely associated with foreign bodies. Sec ondly, the failure of growth could be due to the fact that the infection had already been partially overcome by the initial treatment so that the remaining organisms were so few and nonvirulent that they failed to grow on culture, in spite of careful technique. This would be most likely to occur when the treatment was started early and where the inoculation of the organisms was not deep in the cornea. In nonminers the injury is usually caused by septic material—stone off the road, a thorn, and a cat's claw were three examples in this series. In these cases, the infection is primary and the organisms are inoculated deeply into the cornea. I n miners, most of the injuries occur at the coal-face. T h i s coal is practically sterile (Rhodes, 1941) and therefore infection must be secondary. This secondary infection may be either
Vision than 6/12
\\ orse
Unknown
endogenous or exogenous. Endogenous in fection may come from either the conjunc tiva or from the lacrimal sac. Conjunctival infection is not likely to be severe and should respond quickly to sulfacetamide or antibiotic therapy as the body already has specific antibodies to the organism. Exoge nous infection may come from many sources: the patient's handkerchief, the first-aid attendant's hands, instruments or even the tongue, and finally from the ma terial instilled into the eye. It can be seen, therefore, that first-aid plays a vital part in the treatment and prevention of corneal ulcers, and that inefficient or septic first-aid may do more h a r m than good. F u r t h e r improvement in the prevention and treatment of traumatic corneal ulcers therefore depends on cleanliness in the handling of eye injuries, on the early use of sulfacetamide or antibiotics either at the first-aid post or from the patient's own gen eral practitioner, and finally on the appreci ation of the need for greater vigilance in those injuries where the infection is pri mary. SUMMARY
1. There was no significant difference in the results of traumatic corneal ulcers treated topically with sulfacetamide and terramycin. 2. Traumatic corneal ulcers in miners have a better prognosis than traumatic cor neal ulcers in nonminers. 3. Pathogenic organisms can be cultured
93
TRAUMATIC CORNEAL ULCERS less often from corneal ulcers of miners than from corneal ulcers in nonminers. The reasons for this are discussed. 4. The importance of the preadmission treatment on the ultimate course of the ulcer is stressed. The Royal Infirmary
(3).
ACKNOWLEDGMENTS
I wish to thank Prof. G. I. Scott for permission to publish these cases and for his advice and co operation : also Dr. T. B. M. Durie of the bac teriology department for his help in the bacteriologic aspects of this paper. I have been in receipt of a grant from the W. H. Ross Foundation (Scotland) for the Prevention of Blindness. The terramycin was kindly supplied by Pfizer, Limited.
REFERENCES
Rhodes, A. J.: Studies on the etiology of hypopyon ulcer of the cornea (1941). M.D. Thesis Univer sity of Edinburgh. : Brit. J. Ophth., 23 :637, 1940. Stevenson, E.: Tr. Ophth. Soc. U. Kingdom, 47 :5S, 1927. Scott, G. I.: Tr. Ophth. Soc. U. Kingdom, 74:105, 1954.
T H R O M B I IN T H E CILIARY V E I N S O F E Y E S F R O M N E W B O R N I N F A N T S * V O L C K H E R D T M.
DE GROOT,
M.D.
Detroit, Michigan AND J O N A S S.
FRIEDENWALD,
M.D.
Baltimore, Maryland It is the purpose of this paper to present 10 cases of thrombi in the ciliary veins of newborn infants. A s far as we are aware there is no description of this phenomenon in the literature, either as an isolated finding or in connection with other intraocular dis ease. W e recognized the first case in March, 1953, in the eyes of a Negro newborn child who died in December, 1952. O u t of 75 pairs of eyes from infants who were still born or who died shortly after birth, ex amined in the W i l m e r eye pathology labora tory from March 1, 1953, until March 1, 1954, we collected a total of eight such cases, an incidence of more than 10 percent during that year. * From the Department of Ophthalmology of the Henry Ford Hospital, and the Wilmer Ophthalmological Institute of The Johns Hopkins Uni versity School of Medicine and Hospital. Based on a study carried out in the Wilmer Institute during 1953 and 19S4 and presented in large part before the Wilmer Residents Meeting on April 2, 1954.
Prior to March 1, 1953, the lesion had not been recognized by us. W e therefore reviewed all the slides from newborn and fetal eyes acquired by the W i l m e r eye path ology laboratory prior to March 1, 1953. Over 200 such cases were reviewed, but only two more instances of thrombi in the ciliary veins were found in acquisitions from the years 1935 to 1953. These two had appeared between 1950 and 1953. N o cases were rec ognized in eyes obtained prior to 1950. PATHOLOGIC STUDY OF T H E 10
CASES
W I T H THROMBI A.
OCULAR
FINDINGS
All thrombi appear to have been fresh (figs, l a and l b ) . A rough estimation sug gests they were only a few hours old. Only parts of the ciliary veins are involved, with out any particular location in the ciliary body. Some are in the pars plana, others in the processes. O n e case shows fine retinal hemorrhages, but all nine of the other cases