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Slitlamp Ophthalmoscope
VOL. 62, NO. 1
NOTES, CASES, INSTRUMENTS
161 SUMMARY
A mucocele of the anterior ethmoid sinus presented as a mass along the medial orbital wall. A presumptive diagnosis was made with the help of a positive contrast medium which outlined the extent and location of the mucocele. A positive diagnosis was made by surgical exploration and pathologic ex amination. 1110 N.E. 163rd Street. REFERENCES
1. Corgill, D. A., Holding, B. V., Jr., and Tromly, R. G.: An unusual case of ethmoidal mucocele: Surgical management and ten-year fol low-up. Laryngoscope, 69:1411, 1959. 2. Schlagenhauff, K.: Mucocele in the area of lacrimal sac. Wien. Klin. Wschr. 61:716, 1949. 3. Chandler, J. R., Jr.: Mucoceles: Their diag nosis and treatment. J. Florida M. A. 46:82S, 1960. 4. Cowie, J. W. and Droves, J. D.: Preliminary report on the use of contrast media in orbital ra diography. Brit. J. Ophth. 29:283, 1955. 5. Lombardi, G.: Orbitography with water-sol uble contrast media. Acta Radiologica, 47:417, 1957. 6. Manchester, P. T. and Bonnati, J.: Jodopyracet (Diodrast) injection for orbital tumors. Arch. Ophth. 54:591, 1955. 7. Silva, D.: Personal communication.
SLITLAMP Fig. 2 (Tenzel and Groff). Oblique view, showing mucocele after injection. skin was infiltrated with 2% Xylocaine. Using two 10-cc syringes, a three-way stopcock and a No. 20 gauge needle, the contents of the cavity were aspirated and then filled with the contrast mixture. Roentgenography showed a large mass which filled the anterior ethmoidal cavity and protruded into the orbit (figs. 1 and 2). After X-ray films were taken, the contrast material was removed and the sac was flushed with saline. Surgical exploration through an external fron tal approach revealed a large mucocele involving the region of the anterior ethmoid sinuses. An external frontal ethmoidectomy was performed. During the course of the procedure, a normal lacrimal sac was identified before being retracted from the operative field. It was noted at the time of surgery that there was no inflammatory reaction apparent around the mucocele as a result of the preoperative injection of Renovist.
OPHTHALMOSCOPE
GERALDO QUEIROGA,
M.D.
Belo Horisonte, Brazil I have been working since 1962 on a com pact slitlamp which would serve not only as any common slitlamp but also as an ophthal moscope for indirect ophthalmoscopy. A 6-volt to 8-volt, 15-watt bulb (automobile type) connected to a transformer supplies the light for the instrument. The optics were designed with this bulb as the starting point. Care was taken to avoid using any complex gearing mechanism. Ball-bearings permit the base of the instrument to From the Department of Ophthalmology, Faculty of Medical Sciences, Minas Geraes. This paper was presented at the Pan-American Congress of Ophthalmology, Rio de Janeiro, August, 1965.
162
AMERICAN JOURNAL OF OPHTHALMOLOGY
Fig. 1 (Queiroga). Slitlamp ophthalmoscope. (A) Post for manually controlling movements on a horizontal plane. (B) Area of movement. (C) Knob to break movement. (D) Collar controlling vertical movements. (E) Focusing collar.
move freely in any horizontal plane. There is no need for a special table for the in strument, since it can be placed anywhere. Because this slitlamp has a dual function, OPTICS
07
JULY, 1966
I will refer to it as a slitlamp ophthalmo scope. Its single objective binocular stereo scope microscope, which has a working dis tance of about 80 mm and a field of vision of 12.8 mm, provides a single power of X11.3. The optics of the illuminating system project a parallel light beam that strikes the eye from the cornea to the anterior vitreous at a distance of 70 mm. This part of the in strument, called an illuminator, can be moved laterally in front of the microscope from left to right, or vice versa, stopping at zero degrees for gonioscopy or fundus ex amination (figs. 1 and 2 ) . The light source is focused on the eye by means of the collar ( E ) . The two arrows show this procedure. The new feature which has been inte grated into this instrument is its illuminator. It can be taken out of its holder and con verted into an ophthalmoscope for indirect ophthalmoscopy. The examiner looks at the subject's eye through the top border of the ophthalmosope prism and a + 1 3 D lens, as in routine indirect ophthalmoscopy. A view aperture was found unnecessary. He sees a real and inverted image of the fundus. The slitimage projected on the retina is particularly useful in diagnosing the socalled flat retinal detachment or any other condition in which there is elevation or de pression of the retinal parenchyma.
THE IIXUMDUTOR
■^~:'~
AD
PROJWTDD
SYSTW
Fig. 2 (Queiroga). Optics of the illuminator. (C) Condenser. (S) Slit. (AD) Achromatic doublet. (I) Illuminating lens. (M) Mirror.
VOL. 62, NO. 1
NOTES, CASES, INSTRUMENTS
163
SUPERIOR ORBITAL FISSURE SYNDRONE FOLLOWING TOOTH EXTRACTION LYLE MOSES,
M.D.
Cleveland, Ohio
Fig. 3
(Queiroga). The illuminator disconnected from the unit.
is
By taking the illuminator out of its holder (fig. 3) and moving down the collar ( E ) , one is able to project on the retina a large or thin sharp slit in a vertical, horizontal, or oblique plane. The fundus can be viewed with extreme clarity. Another advantage of this instrument is its circular base, allowing it to be set up on any table. Both the microscope and the illu minator, when prefocused, are manually controlled by the post (A) and can be moved in any direction on a horizontal plane, circumscribed to a definite area (B) (fig. 1). The knob (C) can break this move ment if desired. Vertical movements are carried out by means of the collar ( D ) . The microscope is usually focused with the slit but can be focused separately. This instrument can be used for routine slitlamp eye examination as well as gonioscopy and observation of the fundus by means of the Hruby lens or a special contact lens. It can be used also for indirect ophthalmoscopy. Felipe dos Santos 382.
The complete syndrome of the superior orbital fissure is characterized by paralysis of cranial nerves III, IV and VI, the first branch of cranial nerve V and the sympa thetic nerves. An incomplete syndrome, however, is more the rule than the exception.1 While there have been reports of this condition resulting from neoplasm, trauma, inflammation and infection, there have been no references to its occurrence after tooth extraction. CASE REPORTS CASE 1 H . B., a 60-year-old man, had two right upper molar teeth extracted because of abscesses. On the day after surgery, there was edema of the right eyelids and periorbital area, pain on moving that eye, diplopia and chills and fever. I first saw this patient two days later with the following findings on the right: Corrected vision was 20/20. T h e upper and lower eyelids were edematous, with tenderness on firm palpation of the globe. The bullbar conjuncti va showed moderate chemosis and injection. There was good function of the medial and later al rectus muscles but severely impaired motility of the other extraocular muscles. Pain was pres ent with all eye movements. There was corneal hypesthesia. The pupil, pupillary reactions and ac commodation were normal. There was no ptosis, lymphadenopathy or fever. Slitlamp and funduscopic examinations were normal. Exophthalmometry w a s : R.E., 22 m m ; L.E. 18 mm (100 mm base). General physical examination was nor mal. Skull X-ray films, including orbits and sin uses, were normal. Serologic findings were nega tive. Daily medication, consisting of 1.0 gm of tetracycline orally and 1,200,000 units of procaine peni cillin intramuscularly, was continued for one week, after which all ocular findings were normal. CASE 2
A. K., a 20-year-old man, had a left upper molar extracted because of abscess. On the day after surgery, there was swelling of the left eye lids, fever, headache and diplopia. The patient's From the Mount Sinai Hospital of Cleveland.
NOTES, CASES, INSTRUMENTS
161 SUMMARY
A mucocele of the anterior ethmoid sinus presented as a mass along the medial orbital wall. A presumptive diagnosis was made with the help of a positive contrast medium which outlined the extent and location of the mucocele. A positive diagnosis was made by surgical exploration and pathologic ex amination. 1110 N.E. 163rd Street. REFERENCES
1. Corgill, D. A., Holding, B. V., Jr., and Tromly, R. G.: An unusual case of ethmoidal mucocele: Surgical management and ten-year fol low-up. Laryngoscope, 69:1411, 1959. 2. Schlagenhauff, K.: Mucocele in the area of lacrimal sac. Wien. Klin. Wschr. 61:716, 1949. 3. Chandler, J. R., Jr.: Mucoceles: Their diag nosis and treatment. J. Florida M. A. 46:82S, 1960. 4. Cowie, J. W. and Droves, J. D.: Preliminary report on the use of contrast media in orbital ra diography. Brit. J. Ophth. 29:283, 1955. 5. Lombardi, G.: Orbitography with water-sol uble contrast media. Acta Radiologica, 47:417, 1957. 6. Manchester, P. T. and Bonnati, J.: Jodopyracet (Diodrast) injection for orbital tumors. Arch. Ophth. 54:591, 1955. 7. Silva, D.: Personal communication.
SLITLAMP Fig. 2 (Tenzel and Groff). Oblique view, showing mucocele after injection. skin was infiltrated with 2% Xylocaine. Using two 10-cc syringes, a three-way stopcock and a No. 20 gauge needle, the contents of the cavity were aspirated and then filled with the contrast mixture. Roentgenography showed a large mass which filled the anterior ethmoidal cavity and protruded into the orbit (figs. 1 and 2). After X-ray films were taken, the contrast material was removed and the sac was flushed with saline. Surgical exploration through an external fron tal approach revealed a large mucocele involving the region of the anterior ethmoid sinuses. An external frontal ethmoidectomy was performed. During the course of the procedure, a normal lacrimal sac was identified before being retracted from the operative field. It was noted at the time of surgery that there was no inflammatory reaction apparent around the mucocele as a result of the preoperative injection of Renovist.
OPHTHALMOSCOPE
GERALDO QUEIROGA,
M.D.
Belo Horisonte, Brazil I have been working since 1962 on a com pact slitlamp which would serve not only as any common slitlamp but also as an ophthal moscope for indirect ophthalmoscopy. A 6-volt to 8-volt, 15-watt bulb (automobile type) connected to a transformer supplies the light for the instrument. The optics were designed with this bulb as the starting point. Care was taken to avoid using any complex gearing mechanism. Ball-bearings permit the base of the instrument to From the Department of Ophthalmology, Faculty of Medical Sciences, Minas Geraes. This paper was presented at the Pan-American Congress of Ophthalmology, Rio de Janeiro, August, 1965.
162
AMERICAN JOURNAL OF OPHTHALMOLOGY
Fig. 1 (Queiroga). Slitlamp ophthalmoscope. (A) Post for manually controlling movements on a horizontal plane. (B) Area of movement. (C) Knob to break movement. (D) Collar controlling vertical movements. (E) Focusing collar.
move freely in any horizontal plane. There is no need for a special table for the in strument, since it can be placed anywhere. Because this slitlamp has a dual function, OPTICS
07
JULY, 1966
I will refer to it as a slitlamp ophthalmo scope. Its single objective binocular stereo scope microscope, which has a working dis tance of about 80 mm and a field of vision of 12.8 mm, provides a single power of X11.3. The optics of the illuminating system project a parallel light beam that strikes the eye from the cornea to the anterior vitreous at a distance of 70 mm. This part of the in strument, called an illuminator, can be moved laterally in front of the microscope from left to right, or vice versa, stopping at zero degrees for gonioscopy or fundus ex amination (figs. 1 and 2 ) . The light source is focused on the eye by means of the collar ( E ) . The two arrows show this procedure. The new feature which has been inte grated into this instrument is its illuminator. It can be taken out of its holder and con verted into an ophthalmoscope for indirect ophthalmoscopy. The examiner looks at the subject's eye through the top border of the ophthalmosope prism and a + 1 3 D lens, as in routine indirect ophthalmoscopy. A view aperture was found unnecessary. He sees a real and inverted image of the fundus. The slitimage projected on the retina is particularly useful in diagnosing the socalled flat retinal detachment or any other condition in which there is elevation or de pression of the retinal parenchyma.
THE IIXUMDUTOR
■^~:'~
AD
PROJWTDD
SYSTW
Fig. 2 (Queiroga). Optics of the illuminator. (C) Condenser. (S) Slit. (AD) Achromatic doublet. (I) Illuminating lens. (M) Mirror.
VOL. 62, NO. 1
NOTES, CASES, INSTRUMENTS
163
SUPERIOR ORBITAL FISSURE SYNDRONE FOLLOWING TOOTH EXTRACTION LYLE MOSES,
M.D.
Cleveland, Ohio
Fig. 3
(Queiroga). The illuminator disconnected from the unit.
is
By taking the illuminator out of its holder (fig. 3) and moving down the collar ( E ) , one is able to project on the retina a large or thin sharp slit in a vertical, horizontal, or oblique plane. The fundus can be viewed with extreme clarity. Another advantage of this instrument is its circular base, allowing it to be set up on any table. Both the microscope and the illu minator, when prefocused, are manually controlled by the post (A) and can be moved in any direction on a horizontal plane, circumscribed to a definite area (B) (fig. 1). The knob (C) can break this move ment if desired. Vertical movements are carried out by means of the collar ( D ) . The microscope is usually focused with the slit but can be focused separately. This instrument can be used for routine slitlamp eye examination as well as gonioscopy and observation of the fundus by means of the Hruby lens or a special contact lens. It can be used also for indirect ophthalmoscopy. Felipe dos Santos 382.
The complete syndrome of the superior orbital fissure is characterized by paralysis of cranial nerves III, IV and VI, the first branch of cranial nerve V and the sympa thetic nerves. An incomplete syndrome, however, is more the rule than the exception.1 While there have been reports of this condition resulting from neoplasm, trauma, inflammation and infection, there have been no references to its occurrence after tooth extraction. CASE REPORTS CASE 1 H . B., a 60-year-old man, had two right upper molar teeth extracted because of abscesses. On the day after surgery, there was edema of the right eyelids and periorbital area, pain on moving that eye, diplopia and chills and fever. I first saw this patient two days later with the following findings on the right: Corrected vision was 20/20. T h e upper and lower eyelids were edematous, with tenderness on firm palpation of the globe. The bullbar conjuncti va showed moderate chemosis and injection. There was good function of the medial and later al rectus muscles but severely impaired motility of the other extraocular muscles. Pain was pres ent with all eye movements. There was corneal hypesthesia. The pupil, pupillary reactions and ac commodation were normal. There was no ptosis, lymphadenopathy or fever. Slitlamp and funduscopic examinations were normal. Exophthalmometry w a s : R.E., 22 m m ; L.E. 18 mm (100 mm base). General physical examination was nor mal. Skull X-ray films, including orbits and sin uses, were normal. Serologic findings were nega tive. Daily medication, consisting of 1.0 gm of tetracycline orally and 1,200,000 units of procaine peni cillin intramuscularly, was continued for one week, after which all ocular findings were normal. CASE 2
A. K., a 20-year-old man, had a left upper molar extracted because of abscess. On the day after surgery, there was swelling of the left eye lids, fever, headache and diplopia. The patient's From the Mount Sinai Hospital of Cleveland.