Parasites

234

GENERAL DISEASES

mained. There was no vasomotor disturbance or alteration of respiration. T H E OPHTHALMOCARDIAC REFLEX.—

This attracts wide attention but its literature yields little of interest to the ophthalmologist. Laubry and Harvier believe it acts by exciting the pneumogastric nerve so that its affects are multiple and complete. Opposite results may be obtained when the com-* pression is prolonged from those where it is brief. Petersen thinks the reflex deserves great attention because it is easy to elicit, and more effective than pressure on the nerves. Mougeot and Duverger discuss the reflex in wounded men. Of 190 wounded in the eyes, 5 developed bradycardia probably from concussion; which may act by hypertension of the cerebrospinal fluid. They think that if the reflex reappears after trephining the disturbances are only functional. But when there is no return organic lesions must be assumed. Oppenheim has studied this reflex in 47 men who had suffered from brain concussion, and in 87 whose skull wounds had required trephining. No regularity of the phenomenon could be observed, but he thinks it may afford a valuable basis for estimating the

significance of subjective symptoms. Gorriti's investigations among 72.1 insane showed that the normal reflex was obtained in 589, and no type of mental disease gave exclusively negative findings. Aquini reports a case of hiccough that had continued over 24 hours uncontrolled by other treatment which yielded at once to compression of the eyeballs. The pulse grew slow and the exhausted man fell asleep.' A recurrence next day was aborted by the same procedure. GENERAL PAPERS.—In a paper on some of the general skin diseases with ocular manifestations, based upon 10 cases, Weidler discusses: Acne rosacea, Blepharochalasis. Eczema, Favus, Leprosy, Lupus erythematosvts, Solid edema and Pemphigus. Under the heading "Disturbances of Vision from Pelvic Disorders" Rumsey reports five cases, including: Interstitial keratitis aggravated, and episcleritis recurring at the menstrual period; retinal hyperesthesia, retinitis and optic neuritis. Papers on the relation of the eye to general diseases have been published by Fischer, Alexander, DeBoe and

Adams.

PARASITES. M. URIBE-TRONCOSO, M.

D.,

NEW YORK, N. Y.

This section deals with the animal parasites which affect the eye, whether located in it or elsewhere. It reviews the literature from January, 1917, to September, 1918. MYIASIS OF THE CONJUNCTIVA.—Nav-

arrette y Mas has observed a case of myiasis in a woman, the daughter of a shepherd, who suddenly felt in the left eye a sensation of foreign body with itching and frequent sneezing. Two days afterward she could observe by looking in a mirror, that small, white worms moved in the eye. On examination the author found three worms on the bulbar conjunctiva and six in the upper fornix, which were extracted and proved to be larvae of the species Rhincestrus nasalis (de Geer, 1776).

Maggiore reports the case of a boy, who for eight months had been treated for a circumscribed inflammation in the upper segment of the scleral conjunctiva, without discharge. A transparent cyst was afterwards formed near the sclerocorneal limbus. The upper quadrant of the bulbar conjunctiva showed on examination a large number of dilated veins, superficial and deep; and adherent to the sclera a roundish structure approximating in shape a cigar, about one centimeter long and three millimeters wide. Inspection with the bin-

DIGEST OF THE LITERATURE

ocular microscope revealed the presence of an encysted parasite, disposed in imbricated rings, which after removal was recognized as a fly larva; but. the exact variety could not be determined. An interesting point is the absence of any inflammatory process, and the resemblance to an ordinary lymphatic cyst of the conjunctiva. CYSTICERCUS.—Chistyakoff has written on cysticercus in the eyelid, and v. Herrenschwand on the subretinal variety. But their papers are not available for review. HYDATID

CYSTS.—Demaria

asserts

that although echinococcus is one of the every day affairs of surgical practice in Argentina, where it is very common in the orbit and all parts of the body, the intraocular localization of this parasite has never been described in that country. Even in the whole ophthalmic literature there are only four cases reported, and only one of them is entirely reliable. This is more surprising when contrasted with the cysticercus, which is so frequently found in the interior of the eye. Yet both tenias, the solium and the echin-. ococcus, live and migrate in the same way. Demaria's patient had a secondary glaucoma in the left eye, which was attributed at first to an intraocular tumor. A trephining operation was done; but the relief was temporary, and the pain came back so that the eye was enucleated. Section of the. eyeball produced a clear, transparent liquid, and showed the vitreous completely filled by a cyst, which everywhere veiled the retina and was adherent to it, the ciliary body and the lens. The cystic membrane had the usual characters of the echinococcus; but no free daughter cysts were present, only several proligerous vesicles were adherent to the wall and contained scolices. A very important feature was the absence of a pericystic membrane and of leucocytic infiltration, which the author attributes to the lack of inflammation in the intraocular structures; greatly contrasting with what so commonly occurs in cysticercus cases, where an intense iridocyclitis is almost the rule. In order to ascertain if the echinococcus could be reproduced experiment-

235

ally in the interior of the eye, Demaria made injections of hydatid sand, taken from the liver of man and pig, in the anterior chamber and vitreous of rabbits' eyes. After some months he was able to observe the reproduction of the disease; cysts being formed in the cornea, iris, ciliary body, sclera and vitreous, and also under the retina. He could also demonstrate that the proligerous vesicles, and even the scolices, are able to reproduce echinococcus cysts, as Dave has previously pointed out. FlLARIASIS OF THE

CONJUNCTIVA.

' Stuckey and afterward Trimble, have described under the name of "Circumocular Filariasis" cases of conjunctival worms, found in men and. in one dog, in China. The first author examined a patient complaining of having "worms" in his eye, who produced a bottle containing an object similar to a piece of thread, which he had removed from his right eye two days before. Examination failed at first to disclose anything abnormal on the conjunctiva, but on careful inspection of the upper fornix, an almost invisible body was seen moving freely. Three other worms were also found and extracted, all of them looking like white threads. Trimble's patient had a marked ectropion of the right lower lid and a slight one in the left, which began two months previously with pain, excessive lacrima. tion and later inability to close the eyes. The ectropion was more of a sagging away of the lids, and proved to be due to a complete facial paralysis on the right 'side. There was slight conjunctivitis, but a careful observation brought to light in the superior fornix of the right eye two small worms, of a pink colour and very active, which were easily distinguished from the slightly congested membrane. As soon as these were removed the pain subsided, epiphora disappeared and the muscular tone of the paralyzed area was restored to at least 50 per cent of the normal. The facial paralysis was probably due to the parasitic irritation, extending over three months. Houghton who examined the parasites obtained from Stuckey's case, and another coming from the eye of a dog,

236

PARASITES

declared them to be varieties of the Filaria palpebralis, Wilson, 1884; a neraatode worm commonly affecting the eye of the horse. These filariae have also been found on cattle in France, Belgium and India. Leiper summarizing the reports of these cases believes that, according to the description, the parasites differ from filaria worms in several important respects, both as regards their morphology and development. These worms have been recently (1915) grouped by Railliet in one family; the Thelaziidae, divided in three genera: Thelazia, Ceratospira and Oxyspirura. All parasites found in the eyes of mammals are now confined to the genus Thelazia. The other two genera contain the worms which live in the eyes of birds. In the cases reported above, the parasite was certainly of the Thelazia genus; although it is not certain if it was the T. lacrymalia or the T. callipoeda. Cabaut has observed two cases of filaria loa. In the first the parasite was moving rapidly under the skin of the lower lid, from where it was removed by means of a threaded needle passed around the worm; the thread being immediately tied in order to capture the parasite. A small incision on the skin afforded a way to pull out the filaria. Another worm was seen under the conjunctiva in, the same eye some days afterward and partially removed. Examination of the blood in day time demonstrated great quantities of embryos surrounded by a sheath and marked eosinophilia. In the second patient the parasite was also observed under the conjunctiva. Attempts at extraction were only partially

successful, due to the swiftness of the worm. Pacheco Luna describes some disturbances of vision in patients suffering from a disease known in Guatemala as "Coast erysipelas" and due, according to the researches of Dr. R. Robles, to the infection with a variety of filaria, probably the Onchocerca volvulus, Leuckart, 1893. The doubts still existing about a definite classification are due in part, to the fact that none of the European authors mention among the symptoms produced by this parasite the ocular disturbances, which have been the most important in the author's cases. These disturbances are: photophobia and diminished vision as subjective signs, and objectively a keratitis especially marked in the part disclosed in the palpebral fissure, and consisting of small dot-like whitish, superficial infiltrations similar to the keratitis superficialis punctata of Fuchs, and the central subepithelialis keratitis of Adler. There is no conjunctival or ciliary injection. Iris normal. These lesions run a chronic course lasting for years and when recovery is to be made they diminish, but do not disappear completely, leaving permanent infiltrations. If the disease goes on unchecked the iris becomes involved and a chronic, insidious iritis sets in, with contraction of the pupil and great diminution of sight. At last the dots become more abundant in the lower half of the cornea and form a uniform, diffuse infiltration giving this membrane the appearance of ground glass. The pupil is stretched downward and becomes irregular and occluded.

HYGIENE. J O H N A. M C C A W , M.

D.

DENVER, COLORADO.

This section deals with the hygienic aspects and prophylaxis of conditions and diseases, the other aspects of which are dealt with in preceding sections. It covers the literature from January, 1917, to October, 1918. LIGHTING I N I T S RELATION TO THE

EYE.—In Ferree's work the object has been to compare the effect of different lighting conditions on the eye, and to

find the factors in a given lighting situation which cause the eye to lose in efficiency and to experience discomfort. Tests were made to determine the