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Metastatic Phlegmonous Panophthalmitis
NOTES. CASES A N D INSTRUMENTS
Some operators have thought that the polycoria gave, after the operation, a monocular diplopia. It is not correct. For many reasons, and especially the superior lid normally covers about onefifth of the cornea, this second pupil, so small when well done, is even not seen by the patient, or an uninformed physi cian. Figure 4 shows the introduction of the forceps into the anterior chamber. The peripheral iridectomy, such as is done by us as often as we operate cata ract, has incontestable advantages over the regular iridectomy. Schematically these advantages may be classed as fol lows : (1) No incarceration of the capsule, consequently the risks of a bad cicatri zation of the corneal wound and of in fection are diminished. (2) N o prolapse of the iris as in simple extraction; or of the angles of the coloboma (as in iridectomy of von Graefe), consequently the risks of secondary glaucoma are diminished. (3) No loss of vitreous when the capsule is perforated or the lens ex tracted in toto. (4) Routid pupil and better appear ance. .METASTATIC PHLEGMONOUS. PANOPHTHALMITIS. G . N. B R A Z E A U , M.D. MILWAUKEE, WIS.
This report records a case of the above disease that ran its full course without pain, in spite of great increase of the intraocular pressure. So con trary to our accepted teaching is this fact, that it will not fail to arouse a feeling of doubt in the minds of readers as to the accuracy of the observation. To them, I will say that no one could have experienced more genuine sur prise at discovering the fact than I and Drs. F. and W . Newell, the patient's physicians. The patient, a woman of 46, was re covering from an acute attack of gall bladder trouble when she was sud denly seized with what appeared to be
septic endocarditis. During conva lescence from this, suddenly and dur ing the night, the nurse noticed that the patient's left eye was swelling, so rapidly that by morning the lids were livid and swollen and closed, the eye ball exophthalmic and fixed in the socket and the patient was blind in that eye, tho she did not complain of any pain. On calling I verified all these facts. The fundus was completely dark to illumination and the tension was very high. The cornea was still transparent. The iris was greenish, the aqueous clouded. T o my mind the eye was panophthalmitic. Less than forty-eight hours later the sclera ruptured with evacuation of pus. W e were evidently in the presence of a case of septicemia complicated by the aforementioned conditions, septic endocarditis and pan ophthalmitis. The patient was pro foundly prostrated. The temperature oscillated between 100 and 104. After drainage set in, the temperature began to fall and the patient immediately showed signs of improvement. This was a fulminating case of pan ophthalmitis in every sense of the word without one of its great char acteristics, pain. Painless cases of this disease, that end as this one did, do not belong in the category of this one, nor are they easily confused with it. They are essentially benign in their course, because of the relative benignancy of the products which give rise to them. In them the pus may become encapsu lated, or it may be resorbed, with the result that some sight may be retained. There is nothing, however, to prevent their becoming phlegmonous. In such an instance they assume all the grand symptoms of a phlegmon. In this case of septicemia the focus of infection re sided in the gallbladder, from whence noxious substances entered the circula tion where they attained greater virulency. The infection travels thru the ophthalmic artery to the eye where it sets up a hemorrhagic retinitis with the resulting consequences we have just reported. It was a sad penalty the patient had to pay for this observation. 221 Grand Ave.
Some operators have thought that the polycoria gave, after the operation, a monocular diplopia. It is not correct. For many reasons, and especially the superior lid normally covers about onefifth of the cornea, this second pupil, so small when well done, is even not seen by the patient, or an uninformed physi cian. Figure 4 shows the introduction of the forceps into the anterior chamber. The peripheral iridectomy, such as is done by us as often as we operate cata ract, has incontestable advantages over the regular iridectomy. Schematically these advantages may be classed as fol lows : (1) No incarceration of the capsule, consequently the risks of a bad cicatri zation of the corneal wound and of in fection are diminished. (2) N o prolapse of the iris as in simple extraction; or of the angles of the coloboma (as in iridectomy of von Graefe), consequently the risks of secondary glaucoma are diminished. (3) No loss of vitreous when the capsule is perforated or the lens ex tracted in toto. (4) Routid pupil and better appear ance. .METASTATIC PHLEGMONOUS. PANOPHTHALMITIS. G . N. B R A Z E A U , M.D. MILWAUKEE, WIS.
This report records a case of the above disease that ran its full course without pain, in spite of great increase of the intraocular pressure. So con trary to our accepted teaching is this fact, that it will not fail to arouse a feeling of doubt in the minds of readers as to the accuracy of the observation. To them, I will say that no one could have experienced more genuine sur prise at discovering the fact than I and Drs. F. and W . Newell, the patient's physicians. The patient, a woman of 46, was re covering from an acute attack of gall bladder trouble when she was sud denly seized with what appeared to be
septic endocarditis. During conva lescence from this, suddenly and dur ing the night, the nurse noticed that the patient's left eye was swelling, so rapidly that by morning the lids were livid and swollen and closed, the eye ball exophthalmic and fixed in the socket and the patient was blind in that eye, tho she did not complain of any pain. On calling I verified all these facts. The fundus was completely dark to illumination and the tension was very high. The cornea was still transparent. The iris was greenish, the aqueous clouded. T o my mind the eye was panophthalmitic. Less than forty-eight hours later the sclera ruptured with evacuation of pus. W e were evidently in the presence of a case of septicemia complicated by the aforementioned conditions, septic endocarditis and pan ophthalmitis. The patient was pro foundly prostrated. The temperature oscillated between 100 and 104. After drainage set in, the temperature began to fall and the patient immediately showed signs of improvement. This was a fulminating case of pan ophthalmitis in every sense of the word without one of its great char acteristics, pain. Painless cases of this disease, that end as this one did, do not belong in the category of this one, nor are they easily confused with it. They are essentially benign in their course, because of the relative benignancy of the products which give rise to them. In them the pus may become encapsu lated, or it may be resorbed, with the result that some sight may be retained. There is nothing, however, to prevent their becoming phlegmonous. In such an instance they assume all the grand symptoms of a phlegmon. In this case of septicemia the focus of infection re sided in the gallbladder, from whence noxious substances entered the circula tion where they attained greater virulency. The infection travels thru the ophthalmic artery to the eye where it sets up a hemorrhagic retinitis with the resulting consequences we have just reported. It was a sad penalty the patient had to pay for this observation. 221 Grand Ave.