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Glaucoma following ingestion of sulfathiazole
CORRESPONDENCE
772
( 6 ) neuromuscular aspects, ( 7 ) the vis ual fields, and ( 8 ) the orthoptic treat ment of ocular muscle imbalance follow ing head injuries. This is controversial. The psychological benefit is noted fre quently. " T h e technique of plastic surgery is like that of eye surgery. Every maneuver must be precise, purposeful, clean, and finished. T h e handling of tissue must be the minimum." This quotation from Stallard's article is repeatedly confirmed by the very fine case reports and photo graphs presented. The lessons of World W a r I which have been so thoroughly taught by John Martin Wheeler have been verified again in the field of plastic surgery. T h e Doyne Lecture, " O n Compression and Invasion of the Optic Nerves and Chiasma by Neighboring Gliomas," is of considerable historic interest in reveal ing the development and recognition of the syndrome which was first presented in an extended form by Foster Kennedy. Many individual case reports are scat tered through the transactions. William M. James.
( S i g n e d ) Louis Lehrfeld, Philadelphia, Pennsylvania.
CORRESPONDENCE GLAUCOMA
FOLLOWING
INGESTION
2. T h e pupils were small and irregu lar. 3. T h e fundus was recorded as normal through undilated pupils. 4. T h e pupils, three days after the ori ginal acute attack, were normal in size and reacted briskly to light and accom modation despite the fact that eserine was being used in both eyes. T h e r e is no doubt, from the case re ported, that the patient was allergic to sulfathiazole. The edema of the lids and the C h e m o s i s , plus the intense itching and burning, were indicative of an allergic re action. T h e incidental increase in pres sure is not to be regarded as acute con gestive glaucoma because the pupils were not dilated, the fundus could be seen, and the visual acuity was normal with glasses. I think the authors have made a mis take. All acute inflammatory diseases bringing about edema and Chemosis may be attended by increased pressure of the eyeball by purely a mechanical process. Acute iritis and acute anterior uveitis may be attended by increased intraocu lar pressure. These experiences which register a higher than normal tension on the tonometer are not to be regarded as acute congestive glaucoma.
OF
SULFATHIAZOLE
Editor, American Journal of Ophthalmology: In the February, 1 9 4 7 , issue of the JOURNAL is an article by Fritz and K e s ert reporting a case of glaucoma caused by sulfathiazole. T h e diagnosis of acute congestive glaucoma in the case reported is seriously questioned on the following counts: 1. The vision of either eye was cor rected to normal by glasses.
Editor, American Journal of Ophthalmology: Because of the difficulty in arranging a conference with Dr. Kesert, I will un dertake to answer Dr. Lehrfeld's letter, assuming full responsibility therefore and not presuming, of course, to speak for Dr. Kesert, who might not subscribe fully to what I write. Dr. Lehrfeld thinks that we were mis taken in our diagnosis. Indeed it is pos-
772
( 6 ) neuromuscular aspects, ( 7 ) the vis ual fields, and ( 8 ) the orthoptic treat ment of ocular muscle imbalance follow ing head injuries. This is controversial. The psychological benefit is noted fre quently. " T h e technique of plastic surgery is like that of eye surgery. Every maneuver must be precise, purposeful, clean, and finished. T h e handling of tissue must be the minimum." This quotation from Stallard's article is repeatedly confirmed by the very fine case reports and photo graphs presented. The lessons of World W a r I which have been so thoroughly taught by John Martin Wheeler have been verified again in the field of plastic surgery. T h e Doyne Lecture, " O n Compression and Invasion of the Optic Nerves and Chiasma by Neighboring Gliomas," is of considerable historic interest in reveal ing the development and recognition of the syndrome which was first presented in an extended form by Foster Kennedy. Many individual case reports are scat tered through the transactions. William M. James.
( S i g n e d ) Louis Lehrfeld, Philadelphia, Pennsylvania.
CORRESPONDENCE GLAUCOMA
FOLLOWING
INGESTION
2. T h e pupils were small and irregu lar. 3. T h e fundus was recorded as normal through undilated pupils. 4. T h e pupils, three days after the ori ginal acute attack, were normal in size and reacted briskly to light and accom modation despite the fact that eserine was being used in both eyes. T h e r e is no doubt, from the case re ported, that the patient was allergic to sulfathiazole. The edema of the lids and the C h e m o s i s , plus the intense itching and burning, were indicative of an allergic re action. T h e incidental increase in pres sure is not to be regarded as acute con gestive glaucoma because the pupils were not dilated, the fundus could be seen, and the visual acuity was normal with glasses. I think the authors have made a mis take. All acute inflammatory diseases bringing about edema and Chemosis may be attended by increased pressure of the eyeball by purely a mechanical process. Acute iritis and acute anterior uveitis may be attended by increased intraocu lar pressure. These experiences which register a higher than normal tension on the tonometer are not to be regarded as acute congestive glaucoma.
OF
SULFATHIAZOLE
Editor, American Journal of Ophthalmology: In the February, 1 9 4 7 , issue of the JOURNAL is an article by Fritz and K e s ert reporting a case of glaucoma caused by sulfathiazole. T h e diagnosis of acute congestive glaucoma in the case reported is seriously questioned on the following counts: 1. The vision of either eye was cor rected to normal by glasses.
Editor, American Journal of Ophthalmology: Because of the difficulty in arranging a conference with Dr. Kesert, I will un dertake to answer Dr. Lehrfeld's letter, assuming full responsibility therefore and not presuming, of course, to speak for Dr. Kesert, who might not subscribe fully to what I write. Dr. Lehrfeld thinks that we were mis taken in our diagnosis. Indeed it is pos-