- Email: [email protected]
Glaucoma from Apical Tooth Abscess
NOTES, CASES, GLAUCOMA FROM APICAL TOOTH ABSCESS HARRY H . LEVY, NEW YORK
M.D.
L . E.,* a girl of fourteen years, presented herself for treatment and advice on April 6, 1926, because of headache which had been giving her concern for the previous two weeks. The vision and fundi were normal, and functional tests revealed nothing to give reason to believe that her distress was due to her eyes. On June 14, 1928, she again sought consultation because of spots before the left eye which had been troublesome for the previous twenty-four hours. The vision of each eye was normal, as were the pupillary reactions and the muscle balance. The tension of the left eye felt elevated to the fingers. Taken with the Schiøtz tonometer, the record was 43 mm. H g in the left eye; 18 mm. H g in the right eye. External examination of both eyes was negative. The fundus of the right eye was normal, but in the left eye there was a slight haziness about the disc and a pulsation of the artery. There was no sign of choroiditis anywhere. The anterior chamber of the left eye was deep, the aqueous clear, and there were no deposits on Descemet's. The fields of vision and the blind spots were normal. The patient was treated locally with pilocarpin, and was referred for complete physical examination. At this point she complained of having a "sore tooth", and was advised to have a complete dental examination. The next day the tension of the left eye was found to be 31 mm. H g (Schiøtz), and the following day 28 mm. Hg. The fundus of this eye was negative. Six days later the patient returned. The vision of the left eye was 15/200, with a hazy cornea, active pupillary reaction, and pulsating artery in * T h e case was seen in the oflSce of Dr. K. Schlivek. 991
INSTRUMENTS the fundus. The tension (Schijitz) was 51 mm. Hg. Frequency of the treatment with pilocarpin was increased. Reports of physical examination and of ear, nose, and throat, including x-ray, were negative. X-ray of the teeth revealed an apical abscess in the upper second molar of the right side. Removal of the offending molar was advised. She reported again six days later. The diseased tooth had been extracted and the patient felt better. The vision of the left eye was 15/30—. The cornea was still slightly hazy. The fundus was normal and the tension (Schijitz) 15 mm. H g . The fields of vision and the blind spots were normal. Seven days later the vision of the left eye was found to be normal and the tension to fingers was not elevated. A week later the left eye was again examined and found to be normal. Glaucoma in a young person is not common, and, with an anterior chamber of ordinary depth and normally reacting pupil, the increase of intraocular tension must be secondary. Examination of the fundus did not reveal any evidence of choroiditis, nor was there any sign of iritis. A search for focal infection was obviously indicated. An apical abscess of a molar was found, and upon its removal the intraocular tension of the aflFected eye promptly returned to normal. There can be no doubt that the diseased tooth was the cause of the glaucoma in this case. 1016 Fifth avenue.
A T A B L E OF TONOMETER READINGS LEO
L.
MAYER,
M.D.
CHICAGO
The use of the tonometer is becoming more and more a part in the regular routine examination of the eye. For those who use such a type as McLean's, Bailliart's, or Cohen's, where
M.D.
L . E.,* a girl of fourteen years, presented herself for treatment and advice on April 6, 1926, because of headache which had been giving her concern for the previous two weeks. The vision and fundi were normal, and functional tests revealed nothing to give reason to believe that her distress was due to her eyes. On June 14, 1928, she again sought consultation because of spots before the left eye which had been troublesome for the previous twenty-four hours. The vision of each eye was normal, as were the pupillary reactions and the muscle balance. The tension of the left eye felt elevated to the fingers. Taken with the Schiøtz tonometer, the record was 43 mm. H g in the left eye; 18 mm. H g in the right eye. External examination of both eyes was negative. The fundus of the right eye was normal, but in the left eye there was a slight haziness about the disc and a pulsation of the artery. There was no sign of choroiditis anywhere. The anterior chamber of the left eye was deep, the aqueous clear, and there were no deposits on Descemet's. The fields of vision and the blind spots were normal. The patient was treated locally with pilocarpin, and was referred for complete physical examination. At this point she complained of having a "sore tooth", and was advised to have a complete dental examination. The next day the tension of the left eye was found to be 31 mm. H g (Schiøtz), and the following day 28 mm. Hg. The fundus of this eye was negative. Six days later the patient returned. The vision of the left eye was 15/200, with a hazy cornea, active pupillary reaction, and pulsating artery in * T h e case was seen in the oflSce of Dr. K. Schlivek. 991
INSTRUMENTS the fundus. The tension (Schijitz) was 51 mm. Hg. Frequency of the treatment with pilocarpin was increased. Reports of physical examination and of ear, nose, and throat, including x-ray, were negative. X-ray of the teeth revealed an apical abscess in the upper second molar of the right side. Removal of the offending molar was advised. She reported again six days later. The diseased tooth had been extracted and the patient felt better. The vision of the left eye was 15/30—. The cornea was still slightly hazy. The fundus was normal and the tension (Schijitz) 15 mm. H g . The fields of vision and the blind spots were normal. Seven days later the vision of the left eye was found to be normal and the tension to fingers was not elevated. A week later the left eye was again examined and found to be normal. Glaucoma in a young person is not common, and, with an anterior chamber of ordinary depth and normally reacting pupil, the increase of intraocular tension must be secondary. Examination of the fundus did not reveal any evidence of choroiditis, nor was there any sign of iritis. A search for focal infection was obviously indicated. An apical abscess of a molar was found, and upon its removal the intraocular tension of the aflFected eye promptly returned to normal. There can be no doubt that the diseased tooth was the cause of the glaucoma in this case. 1016 Fifth avenue.
A T A B L E OF TONOMETER READINGS LEO
L.
MAYER,
M.D.
CHICAGO
The use of the tonometer is becoming more and more a part in the regular routine examination of the eye. For those who use such a type as McLean's, Bailliart's, or Cohen's, where