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Ophthalmological Section of the Baltimore City Medical Society
149
SOGIBTT FROCBEDINOS
series of light yellowish spots con centric with the disc. These spots in the choroid were so prominent that they showed thru the clouding in the vitreous. The patient had been struck with a marble or small stone. In a week or so the spots of choroidal exu date disappeared, and the man after ward had a normal fundus. The ap parent rupture of the choroid was probably due to exudate, with actual hemorrhage from the choroid escaping into the vitreous. Senile Neuroretinal Changes. E . R . N e e p e r , Colorado Springs, presented a man, aged eighty years, who had come on account of an opti cian's diagnosis of cataract. Vision had been failing for years. There was atrophy of each optic disc, with an atrophic ring surrounding the disc. Thruout the fundi were disseminated red, white and pigmented patches. Retinal Detachment. E . R . N e e p e r , Colorado Springs, pre sented a woman, aged sixty-four years, who had come originally in September, 1 9 2 1 , on account of two attacks of semiblindness in the right eye during the previous twenty-four hours. A t that time the pupil was dilated and the vitreous hazy, probably from a small hemorrhage. In five days the vi sion of this eye had risen t o 2 0 / 4 0 , but there was little further change in vision during the next twenty months. A somewhat similar attack in May, 1 9 2 3 , was followed by persistence of heavier debris in the vitreous. After a further attack in September, 1 9 2 3 , the vitreous remained cloudy for some time, and after three weeks a large detachment of the retina was visible and vision was 2 0 / 2 0 0 . The vision of the left eye had been steadily 2 0 / 4 0 . Intraocular Foreign Body. E . R . N e e p e r , Colorado Springs, pre sented a man, aged thirty years, who had originally come in April, 1 9 0 9 , on account of injury to the left eye by a splinter of metal, which had broken off while he had been hammering a chisel five days previously. A t that time there was a corneal scar near the limbus, the central lens was cataract-
ous, and vision was light perception. Altho examination had shown the for eign body in the posterior vitreous, surgical interference had been declined. The patient had reappeared for the first time in October, 1 9 2 3 , on account of a small foreign body on the right cornea. The left eye had an active dendritic ulcer, and the whole cornea stained faintly. There were four points of scar tissue in the cornea as tho from previous attacks of keratitis. The vision of the injured eye was doubtful light perception. Should this eye be enucleated, and what was the danger to the other eye? Discussion.
W . C. Bane,
Denver,
felt that the safest thing to do was to enucleate the left eye. E d w a r d J a c k s o n , Denver. The dan ger of sympathetic inflammation in the right eye is probably not imminent, but sympathetic irritation has begun, sooner or later the left eye will have to come out to relieve it, and there is also some danger to the right eye from later sympa thetic inflammation. W . C . FiNNOFF, Denver. The left cornea seems to be steady and the tension increased, and this probably accounts for the corneal changes. W.
H.
Crisp,
C. E .
Walker,
and
A . M c C a w agreed that the eye should come out. Posterior Polar Cataract. Έ . M . M a r b o l t r g , Colorado Springs, presented a man, aged forty-five years, a printer by occupation, who had come on account of failure of vision of the left eye, apparently due to lead poison ing. The right eye had a posterior polar cataract. This eye had been struck with a stick when the patient was a boy, and its vision had been poor ever since. J.
Wm.
H . Crisp, Secretary.
OPHTHALMOLOGICAL SECTION OF T H E BALTIMORE CITY MEDICAL SOCIETY. Nov. 2 2 , 1 9 2 3 . D r . j . W . D o w n e y , Presiding. Iris Inclusion for Glaucoma. Dr. C l a p p showed two cases. A white man of 60 years of age was o p -
150
BALTIMORE
SOCIETY
erated u p o n five m o n t h s a g o f o r acute tion is as frequent as after trephining. g l a u c o m a with retinal h e m o r r h a g e s b y There is also the danger of sympa iridotasis, with tension remaining n o r thetic ophthalmia. C y c l o d i a l y s i s is mal since operation. satisfactory as a preliminary o p e r a t i o n A c o l o r e d girl with simple c h r o n i c and s o m e t i m e s g i v e s p e r m a n e n t relief. g l a u c o m a with tension o f 60. T h r e e T h e result s o u g h t t o b e secured in a w e e k s after the operation tension is peripheral i r i d o t o m y c a n better b e o b reduced t o 40, but fields have n o t e x tained b y an i r i d e c t o m y . panded. I r i d e c t o m y is still the o p e r a t i o n o f c h o i c e , e x c e p t in t h e p r e s e n c e of I n d i c a t i o n s f o r V a r i o u s O p e r a t i o n s in greatly c o n t r a c t e d fields, w h e r e tre Glaucoma. phining s h o u l d b e selected, until it can DR. W M . ZENTMAYER, Philadelphia, be determined whether the claim f o r said the relatively f e w cases seen b y it, that it d o e s n o t p r o d u c e a loss o f any one surgeon compel us to base fixation, is based u p o n fact. our j u d g m e n t in part on t h e statistics I n c o n g e n i t a l g l a u c o m a , unless the and o p i n i o n s o f others. T h e constant case is seen v e r y early, p o s t e r i o r causative factor in s e c o n d a r y glau s c l e r o t o m y is t h e safest and p r o b a b l y c o m a is o b s t r u c t i o n t o the filtration m o s t efficient operation. angle. T h i s is p r e s u m p t i v e e v i d e n c e In g l a u c o m a d u e t o o b s t r u c t i o n o f that the same cause acts t o p r o d u c e it the central vein o f the retina, cyclodi in primary. T h e m o s t important etio alysis is the l o g i c a l operation, b e c a u s e l o g i c factor is a g e with its s c l e r o s i n g of the usually gradual r e d u c t i o n o f tendencies, a n d increase in the size of tension f o l l o w i n g its p e r f o r m a n c e . the lens. In cyclitic g l a u c o m a , paracentesis o f T h e c h o i c e o f operation is influenced the anterior c h a m b e r , k e e p i n g t h e by the type and stage of t h e disease. w o u n d o p e n b y the i n t r o d u c t i o n o f a A basal i r i d e c t o m y is t h e o n l y o p e r a spatula, permits t h e c o n t i n u a n c e o f a tion to be considered in acute c o n g e s cycloplegic. tive g l a u c o m a . T h e cause of the at In o c c l u s i o n o f t h e pupil, i r i d e c t o m y tack is p r o b a b l y s o m e acute disturb is t o b e performed, unless iris b o m b é ance o f metabolism o r vasomotor con has developed, when transfixing o f the trol. S u b s e q u e n t s y s t e m i c disturb iris is indicated. ances o f this nature fail to p r o d u c e Discussion. DR. E . A . K N O R R discussed hypertension b e c a u s e of t h e permanent various iris inclusion operations. T h e late o p e n i n g o f filtration b y the i r i d e c t o m y . Dr. Harlan had performed several at In subacute or c h r o n i c c o n g e s t i v e the Presbyterian Hospital and w a s fa g l a u c o m a , effectual i r i d e c t o m y is diffi v o r a b l y impressed with the results. I n cult to secure. A filtering scar opera six cases reported, four s h o w e d d e tion, o r a c y c l o d i a l y s i s is preferable. creased tension, and three h a d relief If an operation is d e c i d e d u p o n in t h e from pain. N o i m p r o v e m e n t of v i s i o n c h r o n i c simple type w e have the c h o i c e o c c u r r e d in a n y of t h e cases. of several operations, all o f w h i c h have t o d o with t h e iris and this p r o b D R . THEOBALD. Just o n e o b s e r v a t i o n ably results in freeing s o m e p o r t i o n o f made t o m e b y Mr. Higgins of Guy's the angle. H o s p . , L o n d o n , m a n y years a g o " T h a t a badly performed iridectomy reduced T h e o b j e c t i o n s to the Elliot opera the tension better than a classical o n e . " tion are that iritis t o o frequently o c This conforms to m y experience, and c u r s ; that s e c o n d a r y c h a n g e s , usually for several years I have n o t been par in t h e d e v e l o p m e n t o f lenticular opaci ties, s o m e t i m e s o c c u r , p r o b a b l y the re ticular a b o u t r e p l a c i n g all of t h e iris pillars. sult of h y p e r t o n u s ; that late infections are relatively frequent. D R . FRIEDENWALD. T h i s is p r o b a b l y The operation o f iridotasis is t o o the m o s t difficult p r o b l e m in O p h t h a l new t o j u d g e . W h e n w e have the sta mology. M y o w n e x p e r i e n c e is that tistics o f a large number o f operations, i r i d e c t o m y is b e s t f o r acute g l a u c o m a , w e shall p r o b a b l y find that late infec w h i l e in s i m p l e c h r o n i c g l a u c o m a , I
SOCIETY
PROCEEDINGS
rely entirely u p o n the trephine. I n a few cases I have been g r e a t l y disap pointed as the tension has remained high. D R . CROUCH : M y e x p e r i e n c e w i t h the trephine h a s been v e r y unsatisfac tory, late infection, quiet iritis a n d hypotension being the complications seen. I still b e l i e v e that t h e i r i d e c t o m y is t h e operation o f choice, even in simple c h r o n i c g l a u c o m a if taken early, as this has s t o o d t h e test o f time. A s to iridotasis, I have recently p e r f o r m e d this operation in a case w h e r e o n e e y e had been lost, t h e patient h a v i n g a family history o f p r e v i o u s g l a u c o m a . T h e case w a s acute w i t h v e r y h i g h tension a n d w a s f o l l o w e d b y r e d u c t i o n of tension t o n o r m a l and 2 0 / 3 0 v i s i o n . DR.
MCCONACHIE:
M y e x p e r i e n c e in
simple c h r o n i c cases is that t h e y all d o b a d l y if w a t c h e d a sufficient l e n g t h of time. DR.
HIRAM WOODS:
I h a v e seen
an
acute g l a u c o m a d e v e l o p w h i l e e x a m i n ing t h e e y e , w i t h di ation o f pupil, marked increased tension and injection. I should like t o k n o w h o w o n e is t o tell w h e n starting t o treat a case o f acute g l a u c o m a , w h e t h e r it is fulmina ting o r n o t . S o m e cases o f g l a u c o m a stand tension, w i t h n o decrease in v i sion o r fields, while in others a very slight rise o f tension m a y cause b o t h c o n t r a c t i o n o f fields a n d diminution o f vision. Cases w i t h friable iris are m o s t diflficult to operate u p o n . I believe that an iridectomy, all in all, is the best operation. T r e p h i n i n g has n o t been satisfactory in m y hands. D R . T A R U N : R e d u c t i o n o f tension in g l a u c o m a is n o t s o important as retention o f fields a n d acuteness o f v i sion. T h e tension m a y v a r y g r e a t l y . I r i d e c t o m y is still t h e o p e r a t i o n per f o r m e d universally the w o r l d o v e r , a n d in m y o p i n i o n is superior t o all others. I believe a more satisfactory iridec tomy can be done with the Graefe knife than w i t h a spade knife.
161
D R . Z E N T M A Y E R in c l o s i n g s a i d : A badly performed iridectomy probably is efificacious because the iris is re m o v e d at t h e base. T h e o p e r a t i o n of iridotasis is still t o o y o u n g t o r e c e i v e its place in literature. T h e trephine o p e r a t i o n is o n t h e w h o l e in b a d re pute, a n d D r . F u c h s stated in his re cent visit that he had p e r f o r m e d about 1,000 trephine o p e r a t i o n s a n d that h e had a b a n d o n e d it o n a c c o u n t o f late complications. A s t o the operation of c h o i c e in g r e a t l y c o n t r a c t e d fields, t h e trephine s e e m s t o b e m o s t popular, altho most all o f these cases eventually g o blind. A
Contribution as to the Etiology of Hydrophthalmos.
D R . C . A . CLAPP s h o w e d lantern slides o f m i c r o s c o p i c s e c t i o n s o f a case of h y d r o p h t h a l m o s in a c h i l d d y i n g at the a g e o f 10 d a y s w i t h anencephalia. T h e e y e s w e r e g r e a t l y enlarged, there was e d e m a o f t h e c o r n e a l epithelium, thinning o f the substantia propria w i t h i n c o m p l e t e separation o f t h e iris f r o m the cornea, c o n f i r m i n g M r . T r e a c h e r Collins' observations. Discussion.
D R . JONAS F R I E D E N W A L D
inquired if there w a s anything in the orbits to account f o r the exophthalmos. D R . Z E N T M A Y E R : M y case, referred to by D r . Clapp, had a c o l o b o m a o f the iris but with a small root at the base. M i c r o s c o p i c study showed n o canal o f Schlemm. DR.
CLAPP:
A s far as o n e c o u l d de
termine nothing except the greatly en larged eyeballs could account f o r the exophthalmos. C.
SOCIÉTÉ
A.
CLAPP, S E C .
D'OPHTALMOLOGIE DE PARIS.
F e b r u a r y 17, 1923. M.
COUTELA,
President.
Trophic Lesions of Cornea Caused by Unrecognized Foreign Body. DR. ALAN WOODS: In reference to D R . M . BENOIT reported the case o f the danger o f s y m p a t h e t i c trouble d e a m e c h a n i c w h o h a d b e e n injured ten v e l o p i n g from incarceration o f the iris, years b e f o r e in a b o i l e r e x p l o s i o n , after I have seen n o such cases and a m u n w h i c h t h e left e y e w a s under treatment able t o state w h e t h e r t h e d a n g e r is for three weeks, but seemed to have great o r small. r e c o v e r e d w i t h full v i s i o n . F i v e years
SOGIBTT FROCBEDINOS
series of light yellowish spots con centric with the disc. These spots in the choroid were so prominent that they showed thru the clouding in the vitreous. The patient had been struck with a marble or small stone. In a week or so the spots of choroidal exu date disappeared, and the man after ward had a normal fundus. The ap parent rupture of the choroid was probably due to exudate, with actual hemorrhage from the choroid escaping into the vitreous. Senile Neuroretinal Changes. E . R . N e e p e r , Colorado Springs, presented a man, aged eighty years, who had come on account of an opti cian's diagnosis of cataract. Vision had been failing for years. There was atrophy of each optic disc, with an atrophic ring surrounding the disc. Thruout the fundi were disseminated red, white and pigmented patches. Retinal Detachment. E . R . N e e p e r , Colorado Springs, pre sented a woman, aged sixty-four years, who had come originally in September, 1 9 2 1 , on account of two attacks of semiblindness in the right eye during the previous twenty-four hours. A t that time the pupil was dilated and the vitreous hazy, probably from a small hemorrhage. In five days the vi sion of this eye had risen t o 2 0 / 4 0 , but there was little further change in vision during the next twenty months. A somewhat similar attack in May, 1 9 2 3 , was followed by persistence of heavier debris in the vitreous. After a further attack in September, 1 9 2 3 , the vitreous remained cloudy for some time, and after three weeks a large detachment of the retina was visible and vision was 2 0 / 2 0 0 . The vision of the left eye had been steadily 2 0 / 4 0 . Intraocular Foreign Body. E . R . N e e p e r , Colorado Springs, pre sented a man, aged thirty years, who had originally come in April, 1 9 0 9 , on account of injury to the left eye by a splinter of metal, which had broken off while he had been hammering a chisel five days previously. A t that time there was a corneal scar near the limbus, the central lens was cataract-
ous, and vision was light perception. Altho examination had shown the for eign body in the posterior vitreous, surgical interference had been declined. The patient had reappeared for the first time in October, 1 9 2 3 , on account of a small foreign body on the right cornea. The left eye had an active dendritic ulcer, and the whole cornea stained faintly. There were four points of scar tissue in the cornea as tho from previous attacks of keratitis. The vision of the injured eye was doubtful light perception. Should this eye be enucleated, and what was the danger to the other eye? Discussion.
W . C. Bane,
Denver,
felt that the safest thing to do was to enucleate the left eye. E d w a r d J a c k s o n , Denver. The dan ger of sympathetic inflammation in the right eye is probably not imminent, but sympathetic irritation has begun, sooner or later the left eye will have to come out to relieve it, and there is also some danger to the right eye from later sympa thetic inflammation. W . C . FiNNOFF, Denver. The left cornea seems to be steady and the tension increased, and this probably accounts for the corneal changes. W.
H.
Crisp,
C. E .
Walker,
and
A . M c C a w agreed that the eye should come out. Posterior Polar Cataract. Έ . M . M a r b o l t r g , Colorado Springs, presented a man, aged forty-five years, a printer by occupation, who had come on account of failure of vision of the left eye, apparently due to lead poison ing. The right eye had a posterior polar cataract. This eye had been struck with a stick when the patient was a boy, and its vision had been poor ever since. J.
Wm.
H . Crisp, Secretary.
OPHTHALMOLOGICAL SECTION OF T H E BALTIMORE CITY MEDICAL SOCIETY. Nov. 2 2 , 1 9 2 3 . D r . j . W . D o w n e y , Presiding. Iris Inclusion for Glaucoma. Dr. C l a p p showed two cases. A white man of 60 years of age was o p -
150
BALTIMORE
SOCIETY
erated u p o n five m o n t h s a g o f o r acute tion is as frequent as after trephining. g l a u c o m a with retinal h e m o r r h a g e s b y There is also the danger of sympa iridotasis, with tension remaining n o r thetic ophthalmia. C y c l o d i a l y s i s is mal since operation. satisfactory as a preliminary o p e r a t i o n A c o l o r e d girl with simple c h r o n i c and s o m e t i m e s g i v e s p e r m a n e n t relief. g l a u c o m a with tension o f 60. T h r e e T h e result s o u g h t t o b e secured in a w e e k s after the operation tension is peripheral i r i d o t o m y c a n better b e o b reduced t o 40, but fields have n o t e x tained b y an i r i d e c t o m y . panded. I r i d e c t o m y is still the o p e r a t i o n o f c h o i c e , e x c e p t in t h e p r e s e n c e of I n d i c a t i o n s f o r V a r i o u s O p e r a t i o n s in greatly c o n t r a c t e d fields, w h e r e tre Glaucoma. phining s h o u l d b e selected, until it can DR. W M . ZENTMAYER, Philadelphia, be determined whether the claim f o r said the relatively f e w cases seen b y it, that it d o e s n o t p r o d u c e a loss o f any one surgeon compel us to base fixation, is based u p o n fact. our j u d g m e n t in part on t h e statistics I n c o n g e n i t a l g l a u c o m a , unless the and o p i n i o n s o f others. T h e constant case is seen v e r y early, p o s t e r i o r causative factor in s e c o n d a r y glau s c l e r o t o m y is t h e safest and p r o b a b l y c o m a is o b s t r u c t i o n t o the filtration m o s t efficient operation. angle. T h i s is p r e s u m p t i v e e v i d e n c e In g l a u c o m a d u e t o o b s t r u c t i o n o f that the same cause acts t o p r o d u c e it the central vein o f the retina, cyclodi in primary. T h e m o s t important etio alysis is the l o g i c a l operation, b e c a u s e l o g i c factor is a g e with its s c l e r o s i n g of the usually gradual r e d u c t i o n o f tendencies, a n d increase in the size of tension f o l l o w i n g its p e r f o r m a n c e . the lens. In cyclitic g l a u c o m a , paracentesis o f T h e c h o i c e o f operation is influenced the anterior c h a m b e r , k e e p i n g t h e by the type and stage of t h e disease. w o u n d o p e n b y the i n t r o d u c t i o n o f a A basal i r i d e c t o m y is t h e o n l y o p e r a spatula, permits t h e c o n t i n u a n c e o f a tion to be considered in acute c o n g e s cycloplegic. tive g l a u c o m a . T h e cause of the at In o c c l u s i o n o f t h e pupil, i r i d e c t o m y tack is p r o b a b l y s o m e acute disturb is t o b e performed, unless iris b o m b é ance o f metabolism o r vasomotor con has developed, when transfixing o f the trol. S u b s e q u e n t s y s t e m i c disturb iris is indicated. ances o f this nature fail to p r o d u c e Discussion. DR. E . A . K N O R R discussed hypertension b e c a u s e of t h e permanent various iris inclusion operations. T h e late o p e n i n g o f filtration b y the i r i d e c t o m y . Dr. Harlan had performed several at In subacute or c h r o n i c c o n g e s t i v e the Presbyterian Hospital and w a s fa g l a u c o m a , effectual i r i d e c t o m y is diffi v o r a b l y impressed with the results. I n cult to secure. A filtering scar opera six cases reported, four s h o w e d d e tion, o r a c y c l o d i a l y s i s is preferable. creased tension, and three h a d relief If an operation is d e c i d e d u p o n in t h e from pain. N o i m p r o v e m e n t of v i s i o n c h r o n i c simple type w e have the c h o i c e o c c u r r e d in a n y of t h e cases. of several operations, all o f w h i c h have t o d o with t h e iris and this p r o b D R . THEOBALD. Just o n e o b s e r v a t i o n ably results in freeing s o m e p o r t i o n o f made t o m e b y Mr. Higgins of Guy's the angle. H o s p . , L o n d o n , m a n y years a g o " T h a t a badly performed iridectomy reduced T h e o b j e c t i o n s to the Elliot opera the tension better than a classical o n e . " tion are that iritis t o o frequently o c This conforms to m y experience, and c u r s ; that s e c o n d a r y c h a n g e s , usually for several years I have n o t been par in t h e d e v e l o p m e n t o f lenticular opaci ties, s o m e t i m e s o c c u r , p r o b a b l y the re ticular a b o u t r e p l a c i n g all of t h e iris pillars. sult of h y p e r t o n u s ; that late infections are relatively frequent. D R . FRIEDENWALD. T h i s is p r o b a b l y The operation o f iridotasis is t o o the m o s t difficult p r o b l e m in O p h t h a l new t o j u d g e . W h e n w e have the sta mology. M y o w n e x p e r i e n c e is that tistics o f a large number o f operations, i r i d e c t o m y is b e s t f o r acute g l a u c o m a , w e shall p r o b a b l y find that late infec w h i l e in s i m p l e c h r o n i c g l a u c o m a , I
SOCIETY
PROCEEDINGS
rely entirely u p o n the trephine. I n a few cases I have been g r e a t l y disap pointed as the tension has remained high. D R . CROUCH : M y e x p e r i e n c e w i t h the trephine h a s been v e r y unsatisfac tory, late infection, quiet iritis a n d hypotension being the complications seen. I still b e l i e v e that t h e i r i d e c t o m y is t h e operation o f choice, even in simple c h r o n i c g l a u c o m a if taken early, as this has s t o o d t h e test o f time. A s to iridotasis, I have recently p e r f o r m e d this operation in a case w h e r e o n e e y e had been lost, t h e patient h a v i n g a family history o f p r e v i o u s g l a u c o m a . T h e case w a s acute w i t h v e r y h i g h tension a n d w a s f o l l o w e d b y r e d u c t i o n of tension t o n o r m a l and 2 0 / 3 0 v i s i o n . DR.
MCCONACHIE:
M y e x p e r i e n c e in
simple c h r o n i c cases is that t h e y all d o b a d l y if w a t c h e d a sufficient l e n g t h of time. DR.
HIRAM WOODS:
I h a v e seen
an
acute g l a u c o m a d e v e l o p w h i l e e x a m i n ing t h e e y e , w i t h di ation o f pupil, marked increased tension and injection. I should like t o k n o w h o w o n e is t o tell w h e n starting t o treat a case o f acute g l a u c o m a , w h e t h e r it is fulmina ting o r n o t . S o m e cases o f g l a u c o m a stand tension, w i t h n o decrease in v i sion o r fields, while in others a very slight rise o f tension m a y cause b o t h c o n t r a c t i o n o f fields a n d diminution o f vision. Cases w i t h friable iris are m o s t diflficult to operate u p o n . I believe that an iridectomy, all in all, is the best operation. T r e p h i n i n g has n o t been satisfactory in m y hands. D R . T A R U N : R e d u c t i o n o f tension in g l a u c o m a is n o t s o important as retention o f fields a n d acuteness o f v i sion. T h e tension m a y v a r y g r e a t l y . I r i d e c t o m y is still t h e o p e r a t i o n per f o r m e d universally the w o r l d o v e r , a n d in m y o p i n i o n is superior t o all others. I believe a more satisfactory iridec tomy can be done with the Graefe knife than w i t h a spade knife.
161
D R . Z E N T M A Y E R in c l o s i n g s a i d : A badly performed iridectomy probably is efificacious because the iris is re m o v e d at t h e base. T h e o p e r a t i o n of iridotasis is still t o o y o u n g t o r e c e i v e its place in literature. T h e trephine o p e r a t i o n is o n t h e w h o l e in b a d re pute, a n d D r . F u c h s stated in his re cent visit that he had p e r f o r m e d about 1,000 trephine o p e r a t i o n s a n d that h e had a b a n d o n e d it o n a c c o u n t o f late complications. A s t o the operation of c h o i c e in g r e a t l y c o n t r a c t e d fields, t h e trephine s e e m s t o b e m o s t popular, altho most all o f these cases eventually g o blind. A
Contribution as to the Etiology of Hydrophthalmos.
D R . C . A . CLAPP s h o w e d lantern slides o f m i c r o s c o p i c s e c t i o n s o f a case of h y d r o p h t h a l m o s in a c h i l d d y i n g at the a g e o f 10 d a y s w i t h anencephalia. T h e e y e s w e r e g r e a t l y enlarged, there was e d e m a o f t h e c o r n e a l epithelium, thinning o f the substantia propria w i t h i n c o m p l e t e separation o f t h e iris f r o m the cornea, c o n f i r m i n g M r . T r e a c h e r Collins' observations. Discussion.
D R . JONAS F R I E D E N W A L D
inquired if there w a s anything in the orbits to account f o r the exophthalmos. D R . Z E N T M A Y E R : M y case, referred to by D r . Clapp, had a c o l o b o m a o f the iris but with a small root at the base. M i c r o s c o p i c study showed n o canal o f Schlemm. DR.
CLAPP:
A s far as o n e c o u l d de
termine nothing except the greatly en larged eyeballs could account f o r the exophthalmos. C.
SOCIÉTÉ
A.
CLAPP, S E C .
D'OPHTALMOLOGIE DE PARIS.
F e b r u a r y 17, 1923. M.
COUTELA,
President.
Trophic Lesions of Cornea Caused by Unrecognized Foreign Body. DR. ALAN WOODS: In reference to D R . M . BENOIT reported the case o f the danger o f s y m p a t h e t i c trouble d e a m e c h a n i c w h o h a d b e e n injured ten v e l o p i n g from incarceration o f the iris, years b e f o r e in a b o i l e r e x p l o s i o n , after I have seen n o such cases and a m u n w h i c h t h e left e y e w a s under treatment able t o state w h e t h e r t h e d a n g e r is for three weeks, but seemed to have great o r small. r e c o v e r e d w i t h full v i s i o n . F i v e years