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NOTES, CASES, INSTRUMENTS REPORT OF A CASE OF UNILAT ERAL EXOPHTHALMOS D U E TO AN INTRAORBITAL ANEURISM H . L. HlLGARTNER, M.D. W. E. WATT, M.D., F.A.C.S. HENRY L. HILGARTNER, JR., AUSTIN,
M.D.
TEXAS
Wheeler and Hanford have recently reviewed the literature on pulsating exophthalmos and reported an addi tional case; in this case both carotids were ligated, but finally the globe was enucleated. The case of Wheeler and Hanford is similar to ours in that the pulsating exophthalmos in both cases followed an injury. Our patient was first seen on May 12, 1930. He complained of undue pro trusion of the right eye and of a blow ing sound which was synchronous with the heart beat. He also stated that seven months previously he had been stabbed over the right eye, the blade passing in front of the supraorbital ridge down behind the globe. He had been unconscious for some time. When he had regained consciousness, he was annoyed by a blowing sound. On ex amination, the left eye was normal. The right eye showed marked exophthalmos and edema of the conjunctiva; a loud bruit could be heard. R.E.V. 10/200. A diagnosis of aneurism in the orbital fossa was made, in view of the fact that there was no evidence of the knife hav ing entered the cranial cavity. Two days later, on the 14th of May, with the patient under a general anes thetic, a Kronlein operation was per formed. After sufficient exposure had been obtained, a large, pulsating, thickwalled vessel was dissected from the surrounding tissues. The pulsation
339
could be felt along the entire course of the vessel, which extended from the sphenoidal fissure to the globe. After the vessel was ligated twice with heavy silk at its point of emergence through the fissure the pulsation of the globe disappeared. Except for a severe conjunctival edema, which gradually sub sided, the postoperative course was uneventful. In this case the carotid artery was not ligated, because we felt that the aneurism was in the orbit and not be tween the internal carotid artery and the cavernous sinus. That this assump tion was correct was proved by the operative findings and the relief that the patient experienced following the operation. 209 Norwood building. CONTAINERS FOR SOLUTIONS M. F. W E Y M A N N ,
M.D.
LOS ANGELES
A very convenient method of keeping sterile hypertonic solutions for subconjunctival injection is to place them in ordinary rubber-capped vaccine bot tles. These bottles may then be boiled in the ordinary sterilizer for five min utes or longer, after which the solution is removed in the desired amounts by puncturing the cap with the needle as one does with prepared vaccines. The labels are put on these bottles, as well as on all my dropper bottles, with ordinary white oil paint by means of a fine brush. After once becoming drv these labels will not wash off and will even • stand repeated boilings. When brown glass bottles are used the white paint stands out very distinctly. 2007 Wilshire boulevard.
M.D.
TEXAS
Wheeler and Hanford have recently reviewed the literature on pulsating exophthalmos and reported an addi tional case; in this case both carotids were ligated, but finally the globe was enucleated. The case of Wheeler and Hanford is similar to ours in that the pulsating exophthalmos in both cases followed an injury. Our patient was first seen on May 12, 1930. He complained of undue pro trusion of the right eye and of a blow ing sound which was synchronous with the heart beat. He also stated that seven months previously he had been stabbed over the right eye, the blade passing in front of the supraorbital ridge down behind the globe. He had been unconscious for some time. When he had regained consciousness, he was annoyed by a blowing sound. On ex amination, the left eye was normal. The right eye showed marked exophthalmos and edema of the conjunctiva; a loud bruit could be heard. R.E.V. 10/200. A diagnosis of aneurism in the orbital fossa was made, in view of the fact that there was no evidence of the knife hav ing entered the cranial cavity. Two days later, on the 14th of May, with the patient under a general anes thetic, a Kronlein operation was per formed. After sufficient exposure had been obtained, a large, pulsating, thickwalled vessel was dissected from the surrounding tissues. The pulsation
339
could be felt along the entire course of the vessel, which extended from the sphenoidal fissure to the globe. After the vessel was ligated twice with heavy silk at its point of emergence through the fissure the pulsation of the globe disappeared. Except for a severe conjunctival edema, which gradually sub sided, the postoperative course was uneventful. In this case the carotid artery was not ligated, because we felt that the aneurism was in the orbit and not be tween the internal carotid artery and the cavernous sinus. That this assump tion was correct was proved by the operative findings and the relief that the patient experienced following the operation. 209 Norwood building. CONTAINERS FOR SOLUTIONS M. F. W E Y M A N N ,
M.D.
LOS ANGELES
A very convenient method of keeping sterile hypertonic solutions for subconjunctival injection is to place them in ordinary rubber-capped vaccine bot tles. These bottles may then be boiled in the ordinary sterilizer for five min utes or longer, after which the solution is removed in the desired amounts by puncturing the cap with the needle as one does with prepared vaccines. The labels are put on these bottles, as well as on all my dropper bottles, with ordinary white oil paint by means of a fine brush. After once becoming drv these labels will not wash off and will even • stand repeated boilings. When brown glass bottles are used the white paint stands out very distinctly. 2007 Wilshire boulevard.