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Los Angeles Society for Ophthalmology and Otolaryngology
SOCIETY PROCEEDINGS
LOS ANGELES SOCIETY FOR OPHTHALMOLOGY AND OTOLARYNGOLOGY SECTION ON OPHTHALMOLOGY
October 22, 1945 DR. K. C. BRANDENBURG, presiding CLINICAL ASPECTS AND TREATMENT OF EXOPHTHALMOS
FROM
THE
EXPERI-
MENTAL VIEWPOINT DR. HARRY FRIEDGOOD reviewed the anatomic and physiologic aspects of experimental exophthalmos in lower mammals and correlated them with the clinical picture of exophthalmos in man. He stated that it was possible to produce exophthalmos in experimental animals by means of anterior-pituitary injections much more easily after removal of the thyroid gland than before. Dr. Friedgood said that of the various possible explanations for the mechanism of exophthalmos due to thyroid disease, it seemed that edema of the orbital tissues was the most likely. It was concluded by Dr. Friedgood that the exophthalmos of this syndrome goes through two phases, the reversible and irreversible. He said the former was ordinarily encountered in exophthalmic goiter. The latter, he said, occasionally occurs as a postthyroidectomy complication. The evidence, he pointed out, suggested that an exophthalmos-producing (ophthalmotropic) factor in the pituitary gland, distinct from the thyrotropic hormone, induces both types of exophthalmos. The use of the word ophthalmotropic, he said, does not imply that a specific chemical substance having the physiologic action is believed to exist as such in the pituitary gland. Dr. Friedgood said that
1311
because this factor is probably responsible for edema of the orbital tissues, it might be tied in with the important role which the pituitary and thyroid glands play in regulating water metabolism. Although the irreversible or malignant type of exophthalmos cannot always be differentiated in advance from the benign or reversible type, certain clinical criteria aid in the diagnosis. Since edema of the orbit is probably an early pathologic change, one should regard with suspicion any preoperative chemosis, lacrimation, puffiness, or venous congestion of the lids or orbit. The development of hyperthyroidism during iodine therapy or the presence of thyrotropic hormones in the urine should put one on guard, according to Dr. Friedgood, as should a low basalmetabolism rate and increase in blood cholesterol. He also stated that males with slight hyperthyroidism and considerable exophthalmos are peculiarly predisposed to the development of malignant exophthalmos following thyroidectomy. In his opinion operation should be avoided in suspicious cases or, if operation is necessary, the pre- and postoperative administration of desiccated thyroid may prevent the development of hypothyroidism, which is known to favor the development of malignant exophthalmos. NEUROTICISM AMONG ANISEIKONIA PATIENTS DR. K. C. BRANDENBURG, in collaboration with his associate, Dr. Hazel Wentworth, made a preliminary report on a study of the neurotic factor among aniseikonia patients (utilizing the HarrowerErickson modification of the Rorschach test). They had divided a series of 50 patients into three groups and scored them according to their percentage of poor
1312
SOCIETY PROCEEDINGS
answers on the Harrower-Erickson multiple-choice test as follows: Number Median Average Cases Score* Score* percent percent
Group I No symptoms—no aniseikonic test 7 Group II Symptoms—1% or more aniseikonia A. Marked or complete relief 23 B. Partial relief 9 C. No, or only slight 10 Group III Symptoms—No aniseikonia or less than 1% 11
6.5
12
11 23 40
IS 21 39
20
27
* Scoring of H-E Rorschach: 0 percent—no poor answers; 100 percent—all poor answers; under 40 percent—normal; 40 to 50 percent—■ borderline; over 50 percent—disturbed personality.
Dr. Brandenburg called attention to the limited number of cases tested in each group, rendering the reliability of the results somewhat questionable. He also pointed out that the averages for all groups fell within what was considered the normal range of bad answers. There was, however, a definitely greater average of bad answers among aniseikonia patients who received no, or only slight, relief from their correction (39 percent) than among those who received complete relief (15 percent), or only partial relief (21 percent). Whether the
percentage of bad answers within the normal range could be considered a criterion of a degree of neuroticism had not been established experimentally as far as the essayists were aware. Dr. Brandenburg reported that the figures seemed, however, to corroborate the clinical impression that when aniseikonia exists in an individual who does not manifest marked neurotic tendencies, iseikonic lenses are more likely to give lasting relief than in cases wherein the neurotic factor is of greater importance. He stated that the study would continue. PSYCHOLOGIC PROBLEMS OF IMPENDING BLINDNESS
MR. J. MILTON JOHNSON of the Braille
Institute stressed the psychologic importance of acquainting persons with impending blindness with the many activities, useful and diverting, which are available to the blind. He thought it to be desirable that they learn these things from someone who was, or had been, blind and could therefore understand the hopes and fears of one whose vision was failing or had failed. He described the various activities of the Braille Institute of America and asked the cooperation of the eye specialists in making these contacts possible. C. H. Albaugh, Reporter.
LOS ANGELES SOCIETY FOR OPHTHALMOLOGY AND OTOLARYNGOLOGY SECTION ON OPHTHALMOLOGY
October 22, 1945 DR. K. C. BRANDENBURG, presiding CLINICAL ASPECTS AND TREATMENT OF EXOPHTHALMOS
FROM
THE
EXPERI-
MENTAL VIEWPOINT DR. HARRY FRIEDGOOD reviewed the anatomic and physiologic aspects of experimental exophthalmos in lower mammals and correlated them with the clinical picture of exophthalmos in man. He stated that it was possible to produce exophthalmos in experimental animals by means of anterior-pituitary injections much more easily after removal of the thyroid gland than before. Dr. Friedgood said that of the various possible explanations for the mechanism of exophthalmos due to thyroid disease, it seemed that edema of the orbital tissues was the most likely. It was concluded by Dr. Friedgood that the exophthalmos of this syndrome goes through two phases, the reversible and irreversible. He said the former was ordinarily encountered in exophthalmic goiter. The latter, he said, occasionally occurs as a postthyroidectomy complication. The evidence, he pointed out, suggested that an exophthalmos-producing (ophthalmotropic) factor in the pituitary gland, distinct from the thyrotropic hormone, induces both types of exophthalmos. The use of the word ophthalmotropic, he said, does not imply that a specific chemical substance having the physiologic action is believed to exist as such in the pituitary gland. Dr. Friedgood said that
1311
because this factor is probably responsible for edema of the orbital tissues, it might be tied in with the important role which the pituitary and thyroid glands play in regulating water metabolism. Although the irreversible or malignant type of exophthalmos cannot always be differentiated in advance from the benign or reversible type, certain clinical criteria aid in the diagnosis. Since edema of the orbit is probably an early pathologic change, one should regard with suspicion any preoperative chemosis, lacrimation, puffiness, or venous congestion of the lids or orbit. The development of hyperthyroidism during iodine therapy or the presence of thyrotropic hormones in the urine should put one on guard, according to Dr. Friedgood, as should a low basalmetabolism rate and increase in blood cholesterol. He also stated that males with slight hyperthyroidism and considerable exophthalmos are peculiarly predisposed to the development of malignant exophthalmos following thyroidectomy. In his opinion operation should be avoided in suspicious cases or, if operation is necessary, the pre- and postoperative administration of desiccated thyroid may prevent the development of hypothyroidism, which is known to favor the development of malignant exophthalmos. NEUROTICISM AMONG ANISEIKONIA PATIENTS DR. K. C. BRANDENBURG, in collaboration with his associate, Dr. Hazel Wentworth, made a preliminary report on a study of the neurotic factor among aniseikonia patients (utilizing the HarrowerErickson modification of the Rorschach test). They had divided a series of 50 patients into three groups and scored them according to their percentage of poor
1312
SOCIETY PROCEEDINGS
answers on the Harrower-Erickson multiple-choice test as follows: Number Median Average Cases Score* Score* percent percent
Group I No symptoms—no aniseikonic test 7 Group II Symptoms—1% or more aniseikonia A. Marked or complete relief 23 B. Partial relief 9 C. No, or only slight 10 Group III Symptoms—No aniseikonia or less than 1% 11
6.5
12
11 23 40
IS 21 39
20
27
* Scoring of H-E Rorschach: 0 percent—no poor answers; 100 percent—all poor answers; under 40 percent—normal; 40 to 50 percent—■ borderline; over 50 percent—disturbed personality.
Dr. Brandenburg called attention to the limited number of cases tested in each group, rendering the reliability of the results somewhat questionable. He also pointed out that the averages for all groups fell within what was considered the normal range of bad answers. There was, however, a definitely greater average of bad answers among aniseikonia patients who received no, or only slight, relief from their correction (39 percent) than among those who received complete relief (15 percent), or only partial relief (21 percent). Whether the
percentage of bad answers within the normal range could be considered a criterion of a degree of neuroticism had not been established experimentally as far as the essayists were aware. Dr. Brandenburg reported that the figures seemed, however, to corroborate the clinical impression that when aniseikonia exists in an individual who does not manifest marked neurotic tendencies, iseikonic lenses are more likely to give lasting relief than in cases wherein the neurotic factor is of greater importance. He stated that the study would continue. PSYCHOLOGIC PROBLEMS OF IMPENDING BLINDNESS
MR. J. MILTON JOHNSON of the Braille
Institute stressed the psychologic importance of acquainting persons with impending blindness with the many activities, useful and diverting, which are available to the blind. He thought it to be desirable that they learn these things from someone who was, or had been, blind and could therefore understand the hopes and fears of one whose vision was failing or had failed. He described the various activities of the Braille Institute of America and asked the cooperation of the eye specialists in making these contacts possible. C. H. Albaugh, Reporter.