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Early Fifteenth Century Reference to an Interesting Ocular Phenomenon
NOTES, CASES AND
INTERMITTENT EXOPHTHALMOS OF ONE EYE SARADINDU SANYAL,
M.B.
CALCUTTA, INDIA
A Hindu male, aged twenty-five years, came complaining of periodical protrusion of the right eye, especially when he lay down on the bed or bent his head low for some time. The protrusion subsided of its own accord after some time. During the protrusion he did not feel any discomfort or pain in the right eye, nor was vision interfered with. When the patient came there was no exophthalmos, but, on being asked to come when the protrusion occurred, he bent down his head, and within a few minutes the exophthalmos occurred. There was no edema of the lids or conjunctiva, nor were the conjunctival, episcleral, or ciliary vessels seemingly congested. T h e conjunctiva, cornea, and anterior chamber were perfectly normal. The pupil reacted normally. But the tension of the eyeball as registered by the Schiøtz tonometer was 80 mm. Hg. The central vision was good, with slight contraction of the nasal field. The lens and the vitreous humor were perfectly clear. Ophthalmoscopy showed slight engorgement of the veins. The movements of the eyeball were quite normal. The accessory sinuses seemed to be free from pus, as studied by nasopharyngoscope and by transillumination. Comment: This case is peculiar in several respects: (1) exophthalmos of an intermittent character; (2) enlargement of the globe in all its diameters; (3) rise of intraocular tension; (4) absence of signs of increased pressure in the eyeball except slight engorgement of the intraocular veins. This rather peculiar rapid rise and fall of intraocular tension, in t h e absence of any external manifestations of increased tension, has been reported only in some cases of glaucoma after epidemic dropsy. (See American Journal of Ophthalmology, April, 1928, page
42S
INSTRUMENTS
337), but in it there is no exophthalmos and the disease is bilateral. Possibly congenital varix of the orbital veins (Birch-Hirschfeld) and some psychic factor were responsible for the symptoms. Other causes of exophthalmos include ethmoiditis (Weeks) and suppressed menstruation (Teillais). This case is recorded in view of the great rarity of the disorder, de Schweinitz having seen one in 100,000 cases and finding only sixty cases on record. η β Beadon street. EARLY F I F T E E N T H CENTURY REFERENCE TO A N INTEREST ING OCULAR P H E N O M E N O N AARON
BRAV,
M.D.
PHILADELPHIA
Joseph Albo, in his "Sepher Haikkarim" or book of principles (volume 11, page 192), referring to the "likeness of the glory of God", compares it with the appearance of the rainbow, not be cause it is similar to it in appearance, but because the colors seen in the bow are not really such as they seem, the appearance being due to the mixture of different vapors. "This is proven by the fact that the moisture in the eyes sometimes pro duces the appearance of a circle in the air with the colors of the rainbow, though of course there are in reality no such colors". Albo lived in the early part of the fifteenth century and, judging fro'm his many medical references, was probably a physician. I have seen no earlier reference to this ophthalmic phe nomenon in my readings, but I judge that it was probably an old observa tion, since it is quoted in a philosophic treatise. At any rate, it is an interest ing observation, described in the fif teenth century, and deserves t o be re corded in the American Journal of Oph thalmology. Albo's book was written in Hebrew, and has recently been translated by Professor Isaac Husik of the Univer sity of Pennsylvania, who consulted me on the subject for an explanation. 2027 Spruce street.
INTERMITTENT EXOPHTHALMOS OF ONE EYE SARADINDU SANYAL,
M.B.
CALCUTTA, INDIA
A Hindu male, aged twenty-five years, came complaining of periodical protrusion of the right eye, especially when he lay down on the bed or bent his head low for some time. The protrusion subsided of its own accord after some time. During the protrusion he did not feel any discomfort or pain in the right eye, nor was vision interfered with. When the patient came there was no exophthalmos, but, on being asked to come when the protrusion occurred, he bent down his head, and within a few minutes the exophthalmos occurred. There was no edema of the lids or conjunctiva, nor were the conjunctival, episcleral, or ciliary vessels seemingly congested. T h e conjunctiva, cornea, and anterior chamber were perfectly normal. The pupil reacted normally. But the tension of the eyeball as registered by the Schiøtz tonometer was 80 mm. Hg. The central vision was good, with slight contraction of the nasal field. The lens and the vitreous humor were perfectly clear. Ophthalmoscopy showed slight engorgement of the veins. The movements of the eyeball were quite normal. The accessory sinuses seemed to be free from pus, as studied by nasopharyngoscope and by transillumination. Comment: This case is peculiar in several respects: (1) exophthalmos of an intermittent character; (2) enlargement of the globe in all its diameters; (3) rise of intraocular tension; (4) absence of signs of increased pressure in the eyeball except slight engorgement of the intraocular veins. This rather peculiar rapid rise and fall of intraocular tension, in t h e absence of any external manifestations of increased tension, has been reported only in some cases of glaucoma after epidemic dropsy. (See American Journal of Ophthalmology, April, 1928, page
42S
INSTRUMENTS
337), but in it there is no exophthalmos and the disease is bilateral. Possibly congenital varix of the orbital veins (Birch-Hirschfeld) and some psychic factor were responsible for the symptoms. Other causes of exophthalmos include ethmoiditis (Weeks) and suppressed menstruation (Teillais). This case is recorded in view of the great rarity of the disorder, de Schweinitz having seen one in 100,000 cases and finding only sixty cases on record. η β Beadon street. EARLY F I F T E E N T H CENTURY REFERENCE TO A N INTEREST ING OCULAR P H E N O M E N O N AARON
BRAV,
M.D.
PHILADELPHIA
Joseph Albo, in his "Sepher Haikkarim" or book of principles (volume 11, page 192), referring to the "likeness of the glory of God", compares it with the appearance of the rainbow, not be cause it is similar to it in appearance, but because the colors seen in the bow are not really such as they seem, the appearance being due to the mixture of different vapors. "This is proven by the fact that the moisture in the eyes sometimes pro duces the appearance of a circle in the air with the colors of the rainbow, though of course there are in reality no such colors". Albo lived in the early part of the fifteenth century and, judging fro'm his many medical references, was probably a physician. I have seen no earlier reference to this ophthalmic phe nomenon in my readings, but I judge that it was probably an old observa tion, since it is quoted in a philosophic treatise. At any rate, it is an interest ing observation, described in the fif teenth century, and deserves t o be re corded in the American Journal of Oph thalmology. Albo's book was written in Hebrew, and has recently been translated by Professor Isaac Husik of the Univer sity of Pennsylvania, who consulted me on the subject for an explanation. 2027 Spruce street.