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New England Ophthalmological Society
494 Discussion.
SOCIETY P R O C E E D I N G S DR. W . T. DAVIS and
G. VICTOR SIMPSON had used plain catgut in suturing the conjunctival flaps, without irritation. DR.
J. N. GREEAR, JR.
Secretary.
N E W E N G L A N D OPHTHALMOLOGICAL SOCIETY January 15, 1929 DR. W. HOLBROOK LOWELL presiding
Intermittent exophthalmos DR. HUGO B. C. RIEMER presented a
case, seen for the first time on Decem ber 23, 1928, in a girl of twelve years, referred to the clinic by her family doctor, who noticed that on stooping forward the left eye protruded. She had had scarlet fever, whooping cough, chicken pox, and "trench mouth." Otherwise she had been per fectly healthy and well. There was no history of injury. Protrusion of the eye was first no ticed by her mother last summer on coming out of the water after bath ing. Vision in both eyes was 20/15; eye grounds normal. When the exophthalmos was present there was no apparent difference in the size of the retinal veins. T h e left lid was slightly more drooped than the right. After stooping over for ten or fifteen sec onds a definite exophthalmos of the left eye was seen. This exophthal mos could not be elicited by compres sion of the left facial vein or by compression of the left jugular vein, but on compressing both jugulars in the upright position an exophthalmos of three millimeters appeared, and likewise when the patient stooped. The x-ray and physical findings were negative. In reviewing the literature Dr. Riemer found that there had been over fifty such cases reported, and that the exact cause was still doubt ful. Krause had reported post-mor tem examination of four cases in which there were definite varicose veins, greatly enlarged vessels of the orbit. Krause believed these were
present at birth or developed shortly afterward. H e pointed out that the orbital veins had narrow valves. An other interesting thing was that he believed the major part of the venous blood to be carried in these veins, and that the lumen became narrow as they entered the cavernous sinus. Dr. Riemer thought with Birch-Hirschfeld that the condition was due to an ob struction to the flow of the venous blood anteriorly. Contact glass in keratoconus DR. GEORGE S. DERBY presented a pa
tient who had keratoconus. Her vis ion improved very much with the use of the contact glass. Today she had worn the glass for six hours. She said she saw very much better with it than she had seen for years. She read 20/30 in Dr. Derby's of fice today, and she read next to the smallest line of reading type. She could put the glass in herself and wear it without any special irrita tion. Of course it had to be filled with physiological salt solution be fore application. Dr. Derby was trying to discover which of the four kinds of contact glass at his disposal was the best for the patient. Best vision was obtained with a minus twelve cylinder; a rather strong cylinder to wear. The only difficulty seemed to be in taking the glass out. She still had to use one-half per cent solution of holocain before inserting it. Amblyopia without organic lesion Du. DERBY reported a case which was unusual in his experience. A perfect ly healthy man, forty-eight years of age, whom he had seen on two occa sions in his office, had an amblyopic right eye, which was about eight diop ters astigmatic. T h e left eye was ap parently normal. T h e appearance and fundus examination of the amblyopic eye were entirely negative except for the effect of the astigmatism in pro ducing an oval disc. The vision was so low in this eye that the patient saw only light. H e could not count
495
SOCIETY PROCEEDINGS
fingers or see hand movements unless the object was between him and the light. Dr. Derby thought that if the eye were taken out and sectioned it would probably show a perfectly nor mal retina, and he likened it to the blind area of retina which was pres ent in the temporal periphery of every eye.
often, sometimes about three times a week. Phacoerisis by method of Barraquer DR. WILLIAM MCLEAN gave a mov ing picture exhibit illustrating opera tions by this method.
Gold chloride stain for corneal opaci ties
CHICAGO OPHTHALMOLOGICAL SOCIETY December 17, 1928
DR. EDWIN
B.
DUNPHY
showed
a
woman aged thirty-five years, whose right cornea was completely white from old interstitial keratit's. T h e eye was sightless and diverged about thirty degrees. An operation had been done for cosmetic purposes ac cording to the Knapp technique. T h e epithelium was denuded centrally for an area about three millimeters in diameter, and four per cent gold chloride solution on a cotton swab was placed on the denuded area for two minutes. Then several drops of adrenalin chloride solution 1 to 1000 were put on this area. This caused the area to stain a dark brown. Re covery was uneventful, leaving a good looking artificial pupil. Pemphigus of the conjunctiva Dr. Edwin B. Dunphy presented for DR. PAUL A. CHANDLER a woman fiftythree years old, having a history of sore eyes over a period of seventeen years. She showed an extensive scar ring of the lids, with adhesions be tween the palpebral and the bulbar conjunctiva, at first thought to be tra choma. T h e adhesions had been cut several times but always grew to gether. T h e vision was 20/30 in the left eye. There was nothing on the cornea. T h e lids were a mass of ad hesions. Discussion. DR. W. HOLBROOK LOWELL
stated that pemphigus was a disease concerning which no one seemed to know much. A case was turned over to him about twenty-five years ago. The patient had adhesions and symblepharon and was irritated especially by the lashes turning in. Some of these lashes had to be removed quite
S. JUDD BEACH.
Secretary.
GEORGE FRANCIS SUKER, president
Two cases of intraocular foreign body (wood, metal) DR.
M. L. FOLK presented
a man
thirty-one years of age, whose history was that three weeks ago, while split ting wood, several splinters had struck the right eye. Upon examination there was found a rent in the sclera, three to four millimeters long and six millimeters temporal to the limbus, and through which vitreous was pro truding. T h e vitreous was hazy and contained numerous floaters. T h e prolapsed vitreous was replaced and the eye sutured. X-ray taken on the third clay disclosed a foreign body, probably wood. T h e eye was now quiet and it was decided to wait for further developments. Vision was 0.6. The foreign body could not be seen with the ophthalmoscope or the slitlamp. The second case was one of pene tration of the eye by a piece of metal. The patient was not seen until three weeks after the accident, when exam ination disclosed some opacity in the cornea and in the lens. X-ray showed a foreign body. T h e giant magnet was tried unsuccessfully. Dr. Gradle, in consultation, advised leaving the eye alone at present. It was now free from injection and the vision was 0.5. The uveitis had entirely cleared up. Discussion.
DR. T. A. ALLEN recalled
a case shown before the society last year which was interesting because of the fact that there was a good deal of wood in the orbit, not revealed by x-ray.
SOCIETY P R O C E E D I N G S DR. W . T. DAVIS and
G. VICTOR SIMPSON had used plain catgut in suturing the conjunctival flaps, without irritation. DR.
J. N. GREEAR, JR.
Secretary.
N E W E N G L A N D OPHTHALMOLOGICAL SOCIETY January 15, 1929 DR. W. HOLBROOK LOWELL presiding
Intermittent exophthalmos DR. HUGO B. C. RIEMER presented a
case, seen for the first time on Decem ber 23, 1928, in a girl of twelve years, referred to the clinic by her family doctor, who noticed that on stooping forward the left eye protruded. She had had scarlet fever, whooping cough, chicken pox, and "trench mouth." Otherwise she had been per fectly healthy and well. There was no history of injury. Protrusion of the eye was first no ticed by her mother last summer on coming out of the water after bath ing. Vision in both eyes was 20/15; eye grounds normal. When the exophthalmos was present there was no apparent difference in the size of the retinal veins. T h e left lid was slightly more drooped than the right. After stooping over for ten or fifteen sec onds a definite exophthalmos of the left eye was seen. This exophthal mos could not be elicited by compres sion of the left facial vein or by compression of the left jugular vein, but on compressing both jugulars in the upright position an exophthalmos of three millimeters appeared, and likewise when the patient stooped. The x-ray and physical findings were negative. In reviewing the literature Dr. Riemer found that there had been over fifty such cases reported, and that the exact cause was still doubt ful. Krause had reported post-mor tem examination of four cases in which there were definite varicose veins, greatly enlarged vessels of the orbit. Krause believed these were
present at birth or developed shortly afterward. H e pointed out that the orbital veins had narrow valves. An other interesting thing was that he believed the major part of the venous blood to be carried in these veins, and that the lumen became narrow as they entered the cavernous sinus. Dr. Riemer thought with Birch-Hirschfeld that the condition was due to an ob struction to the flow of the venous blood anteriorly. Contact glass in keratoconus DR. GEORGE S. DERBY presented a pa
tient who had keratoconus. Her vis ion improved very much with the use of the contact glass. Today she had worn the glass for six hours. She said she saw very much better with it than she had seen for years. She read 20/30 in Dr. Derby's of fice today, and she read next to the smallest line of reading type. She could put the glass in herself and wear it without any special irrita tion. Of course it had to be filled with physiological salt solution be fore application. Dr. Derby was trying to discover which of the four kinds of contact glass at his disposal was the best for the patient. Best vision was obtained with a minus twelve cylinder; a rather strong cylinder to wear. The only difficulty seemed to be in taking the glass out. She still had to use one-half per cent solution of holocain before inserting it. Amblyopia without organic lesion Du. DERBY reported a case which was unusual in his experience. A perfect ly healthy man, forty-eight years of age, whom he had seen on two occa sions in his office, had an amblyopic right eye, which was about eight diop ters astigmatic. T h e left eye was ap parently normal. T h e appearance and fundus examination of the amblyopic eye were entirely negative except for the effect of the astigmatism in pro ducing an oval disc. The vision was so low in this eye that the patient saw only light. H e could not count
495
SOCIETY PROCEEDINGS
fingers or see hand movements unless the object was between him and the light. Dr. Derby thought that if the eye were taken out and sectioned it would probably show a perfectly nor mal retina, and he likened it to the blind area of retina which was pres ent in the temporal periphery of every eye.
often, sometimes about three times a week. Phacoerisis by method of Barraquer DR. WILLIAM MCLEAN gave a mov ing picture exhibit illustrating opera tions by this method.
Gold chloride stain for corneal opaci ties
CHICAGO OPHTHALMOLOGICAL SOCIETY December 17, 1928
DR. EDWIN
B.
DUNPHY
showed
a
woman aged thirty-five years, whose right cornea was completely white from old interstitial keratit's. T h e eye was sightless and diverged about thirty degrees. An operation had been done for cosmetic purposes ac cording to the Knapp technique. T h e epithelium was denuded centrally for an area about three millimeters in diameter, and four per cent gold chloride solution on a cotton swab was placed on the denuded area for two minutes. Then several drops of adrenalin chloride solution 1 to 1000 were put on this area. This caused the area to stain a dark brown. Re covery was uneventful, leaving a good looking artificial pupil. Pemphigus of the conjunctiva Dr. Edwin B. Dunphy presented for DR. PAUL A. CHANDLER a woman fiftythree years old, having a history of sore eyes over a period of seventeen years. She showed an extensive scar ring of the lids, with adhesions be tween the palpebral and the bulbar conjunctiva, at first thought to be tra choma. T h e adhesions had been cut several times but always grew to gether. T h e vision was 20/30 in the left eye. There was nothing on the cornea. T h e lids were a mass of ad hesions. Discussion. DR. W. HOLBROOK LOWELL
stated that pemphigus was a disease concerning which no one seemed to know much. A case was turned over to him about twenty-five years ago. The patient had adhesions and symblepharon and was irritated especially by the lashes turning in. Some of these lashes had to be removed quite
S. JUDD BEACH.
Secretary.
GEORGE FRANCIS SUKER, president
Two cases of intraocular foreign body (wood, metal) DR.
M. L. FOLK presented
a man
thirty-one years of age, whose history was that three weeks ago, while split ting wood, several splinters had struck the right eye. Upon examination there was found a rent in the sclera, three to four millimeters long and six millimeters temporal to the limbus, and through which vitreous was pro truding. T h e vitreous was hazy and contained numerous floaters. T h e prolapsed vitreous was replaced and the eye sutured. X-ray taken on the third clay disclosed a foreign body, probably wood. T h e eye was now quiet and it was decided to wait for further developments. Vision was 0.6. The foreign body could not be seen with the ophthalmoscope or the slitlamp. The second case was one of pene tration of the eye by a piece of metal. The patient was not seen until three weeks after the accident, when exam ination disclosed some opacity in the cornea and in the lens. X-ray showed a foreign body. T h e giant magnet was tried unsuccessfully. Dr. Gradle, in consultation, advised leaving the eye alone at present. It was now free from injection and the vision was 0.5. The uveitis had entirely cleared up. Discussion.
DR. T. A. ALLEN recalled
a case shown before the society last year which was interesting because of the fact that there was a good deal of wood in the orbit, not revealed by x-ray.