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Gunshot Wound of Orbit, Operation, Recovery
GUNSHOT WOUND OF ORBIT
"Writers apparently have described many tumors of this type as endotheliomata, but Ewing states that most of these are probably cancer of the lacrimal gland. It is easy to see how the idea of endothelioma might be obtained. On ac count of its rarity, I intend to have minute descriptions and photomicro graphs of the tumor prepared for teach ing purposes. I can send you some of these if you so desire. "The distribution of metastasis is rather remarkable for cancer, but I be lieve can be accounted for by the ex tremely long time the patient survived
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the primary operation. If on further study any new conclusion is reached, I will let you know at once." The accompanying photographs were later supplied and labeled by Dr. E. V. Heahn, of Indianapolis, coworker with Dr. Gotch. According to an article by' Dr. Lane in the American Journal of Ophthalmology for June, 1922, (v. 5, p. 425), it would seem that in the literature there have been reported only nine other cases of metastasis following tumor of the lacri mal gland. Seven of these were verified at autopsy and two were not.
GUNSHOT W O U N D OF ORBIT, OPERATION, RECOVERY. JAMES A. MORGAN,
M.D.
H O N O L U L U , T. H .
P. Cho., Korean, age 21 chauffeur. During a family row, and while under the influence of okolehao (a native Hawaiian intoxicating drink), the patient drew a 32 calibre revolver and fired three shots at his wife, whom he missed. Then he placed the gun to the right side of his face and fired one shot. Patient was brought into the hospital in an uncon scious condition. There was a small
I'tg. 1-—(Gunshot wound of orbit (Moi-pan's case).
perforating wound on right side of the face just below the malar bone; which was blackened with powder, and bleed ing profusely. The right eye was swollen shut. Palliative measures were carried out for twenty-four hours, until the patient had regained consciousness, when an ex amination was made. Eyelids were swollen and edematous. Vision was re-
Front view showing foreign bodies in right orbit.
130
JAMES A. MORGAN
duced to counting fingers at close range. Ophthalmologic examination at this time revealed overfilled veins and a hazy nervehead. X-ray showed a bullet in the posterior orbit; and the lateral view
pathway of the bullet was followed, and it was found lying on the optic nerve about one inch posterior to the globe. Apparently there had been no injury to the nerve, as the ultimate recovery with-
i'ig. 2.—Side view of Morgan's case showing depth of foreign bodies in the orbit.
a number of fragments along the track of the bullet. Kronlein's technic was used, but upon uncovering the bone of the right external orbital it was found so fragmented that it had to be removed in pieces. The
out loss of vision shows. The patient made an uneventful recovery and when last seen, two weeks after the operation, there were no apparent eyeground changes, and the vision had improved to 20/40.
"Writers apparently have described many tumors of this type as endotheliomata, but Ewing states that most of these are probably cancer of the lacrimal gland. It is easy to see how the idea of endothelioma might be obtained. On ac count of its rarity, I intend to have minute descriptions and photomicro graphs of the tumor prepared for teach ing purposes. I can send you some of these if you so desire. "The distribution of metastasis is rather remarkable for cancer, but I be lieve can be accounted for by the ex tremely long time the patient survived
129
the primary operation. If on further study any new conclusion is reached, I will let you know at once." The accompanying photographs were later supplied and labeled by Dr. E. V. Heahn, of Indianapolis, coworker with Dr. Gotch. According to an article by' Dr. Lane in the American Journal of Ophthalmology for June, 1922, (v. 5, p. 425), it would seem that in the literature there have been reported only nine other cases of metastasis following tumor of the lacri mal gland. Seven of these were verified at autopsy and two were not.
GUNSHOT W O U N D OF ORBIT, OPERATION, RECOVERY. JAMES A. MORGAN,
M.D.
H O N O L U L U , T. H .
P. Cho., Korean, age 21 chauffeur. During a family row, and while under the influence of okolehao (a native Hawaiian intoxicating drink), the patient drew a 32 calibre revolver and fired three shots at his wife, whom he missed. Then he placed the gun to the right side of his face and fired one shot. Patient was brought into the hospital in an uncon scious condition. There was a small
I'tg. 1-—(Gunshot wound of orbit (Moi-pan's case).
perforating wound on right side of the face just below the malar bone; which was blackened with powder, and bleed ing profusely. The right eye was swollen shut. Palliative measures were carried out for twenty-four hours, until the patient had regained consciousness, when an ex amination was made. Eyelids were swollen and edematous. Vision was re-
Front view showing foreign bodies in right orbit.
130
JAMES A. MORGAN
duced to counting fingers at close range. Ophthalmologic examination at this time revealed overfilled veins and a hazy nervehead. X-ray showed a bullet in the posterior orbit; and the lateral view
pathway of the bullet was followed, and it was found lying on the optic nerve about one inch posterior to the globe. Apparently there had been no injury to the nerve, as the ultimate recovery with-
i'ig. 2.—Side view of Morgan's case showing depth of foreign bodies in the orbit.
a number of fragments along the track of the bullet. Kronlein's technic was used, but upon uncovering the bone of the right external orbital it was found so fragmented that it had to be removed in pieces. The
out loss of vision shows. The patient made an uneventful recovery and when last seen, two weeks after the operation, there were no apparent eyeground changes, and the vision had improved to 20/40.