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The Brooklyn Ophthalmological Society
SOCIETY
PROCEEDINGS
bruit, and the patient stated the noise on the right side o f the head had ceased. The swelling o f the lids and the p r o p tosis gradually receded, and three months following the operation, the exophthal mometer reveals recession o f the prop tosis from 1 0 to 5 mm. and the swelling of the lids reduced to almost normal. T h e patient has been comfortable since the operation. DR. T . B . HOLLOWAY stated that what was said about the orbital operation was correct at the time it was written. H e pointed out that ligation o f the c o m m o n carotid was not free from cerebral c o m plications and that the statistics o f Siegrist give an incidence o f about 8 per cent. Still further, in a few instances, ocular complications have arisen. It is true that these statistics run back f o r years and that local conditions such as infection and secondary hemorrhage are now less frequently encountered. O n the other hand, he questioned whether the observations concerning cerebral complications were as accurately re corded as those following ligation o f the orbital vein. Dr. H o l l o w a y stated that he could only repeat a previous statement to the effect, that if he should develop a pulsating e x ophthalmos he would probably prefer a slow ligation o f the c o m m o n carotid, but certainly a ligation o f the orbital vein before a ligation o f the other carotid. After all was said, a number o f factors should determine the character o f the treatment, such as the age o f the patient, the extent and character o f the injury, the associated medical conditions, and the local signs. DR. ZENTMAYER said that he thought Dr. H o l l o w a y touched o n the important point in the management o f these cases when he said that it depended somewhat on the degree o f exophthalmos and the general condition o f the patient. T h e case which he had just shown was not greatly annoyed by the bruit, the exoph thalmos is not extreme, and there is neither disfiguring Chemosis n o r redness of the conjunctiva, so that he had not strongly urged a radical procedure and the patient did not feel that she would care to submit to an operation which might prove serious.
873
Mikulicz's Disease. D R . J O H N P . O ' B R I E N exhibited a case
o f Mikulicz's disease in a colored w o man, aged 2 4 years. Examination re vealed enlarged lacrimal and parotid glands; otherwise the physical examina tion was negative. History shows no T . B . ; no miscarriages; V o n Pirquet slightly positive; Wassermann negative; urin alysis trace o f albumin; leucocytosis 1 2 , 0 0 0 ; differential normal; red cells 3,320,000;
hemoglobin
fundus negative. hygienic. Discussion.
65
per
cent;
Treatment, tonics and
DR. S.
LEWIS
ZIEGLER
stated that he had personally observed five cases o f Mikulicz's disease and had reported three cases. T h e characteristic sign o f "blood-hound faciés," to which he had called attention, was absent in this case, as the lacrimal glands alone were decidedly enlarged, but the parotids were only slightly more prominent than usual. T h e other glands were negative. H e thought it was always necessary to search f o r respiratory obstruction, and to treat it i f indicated so as to relieve the suboxidation which caused the gland ular hypertrophy. H e had found such lesions in all his cases, and had relieved two b y tonsillectomy a n d o n e b y nasal cauterization. T h e olher t w o were re ferred t o the rhinologist f o r similar treatment, but he did not know the final result. H e thought a similar examina tion in this case might reveal some o b struction to breathing that might prove to be a causative factor. C.
E . G. S H A N N O N , Clerk.
THE BROOKLYN OPHTHAL MOLOGICAL SOCIETY. APRIL
19, 1924.
Glaucoma and the Endocrins. DR.
PERCY FRIDENBERG, o f N e w Y o r k
City, read the paper elsewhere published in full in this issue, page 8 6 0 . Discussion. D R . F . BAILEY. I was in hopes D r . Fridenberg would give us some o f the results o f treatment in con nection with the endocrins. D R . D E E L E Y . — P r o f . Imre found by the tonometer a reduction in tension in preg nancy. I would like t o ask if that is
874
BROOKLYN
OPHTHALMOLOGICAL
due to excitement o f the thyroid. I n a General Hospital with obstetric service I found in fifteen cases the tension ranged from 9 to 1 8 . DR.
STEINBUGLER
H o w can w e e x
plain reduction o f tension b y atropin in cyclitis ? DR.
FRIDENBERG
In
addition to
the
late infections one danger o f the Elliot operation is that o f traumatism to an eye so delicately covered. I did not touch on simple chronic glaucoma; as some claim it is o f different origin from the inflammatory, being, perhaps, a form of optic nerve atrophy. I would rather not deal with the treatment f o r it is still too much in the experimental stage. O u r experiments according to Prof. Imre's suggestions were not satisfactory. Thyroid activity is on the side o f sym pathetic irritation and high tension. T h e pituitary is involved in pregnancy. Sympathetic paralysis means contrac tion o f pupil and l o w tension. Sym pathetic irritation means dilatation and plus tension. Herpes zoster gives plus tension, while degenerative conditions with anesthesia gave minus tension. Sometimes pilocarpin instilled in the eye does not lower the tension, whereas given by hypodermic it causes sweating and lowering o f tension. Perhaps in ocular medication it m a y be absorbed and aflrect the endocrin balance. Glau coma comes o n at a time when the pupil is normally small and more frequently in hyperopia, yet produces a dilatation of the pupil which will not contract. W h y ? W e d o not know. W.
M . GARDNER, M . D .
Secretary.
COLORADO OPHTHALMOLOG ICAL SOCIETY APRIL 1 9 , 1924. DR.
R.
SPENCER
and
C. L.
the optic nerve. There were a number o f heavy floaters in the vitreous. T h e vision o f the injured eye was 1 / 6 0 . C o l o b o m a o f Iris a n d C h o r o i d . J A M E S M . SHIELDS, D e n v e r , presented
a boy aged eleven years w h o had bilateral coloboma o f the iris associated with c o l o boma o f the choroid. T h e patient was one o f eight children. N o other member of the family had any ocular defect known to the parents, but a brother o f the mother had a similar defect. T h e iris coloboma extended to the sclera, and the notched lower edge o f each lens was clearly visible. T h e choroidal coloboma in the right eye extended a g o o d deal higher than in the left, and in the right eye the optic disc was missing, altho the retinal vessels could be seen at the normal position o f the disc. T h e vision was R . moving objects in the lower part of the field, L . 1 0 / 2 0 with a minus cor rection. I n j u r y I n v o l v i n g Ciliary B o d y . W . F . M A T S O N , Denver, again pre sented the case o f magnet extraction o f a foreign b o d y previously shown at the February, 1 9 2 4 , meeting. T h e e y e had been severely inflamed, but had become quieter after intravenous injection o f sixteen grain doses o f sodium salicylat every other day f o r several doses. There was very little vision, but the e y e was fairly quiet, altho it w o u l d be removed if any decided exacerbation occurred. Discussion. C. E . W A L K E R , Denver, suggested that on account o f the w o u n d being thru the ciliary body the eye was fikely t o get worse and it would be proper to remove it. W . C . B A N E , Denver, thought that the eye was improving and that it w o u l d be well to wait. MELVILLE BLACK, Denver.
W . A . SEDWICK, Presiding.
Gun Shot Inquiry. F.
SOCIETY
L A RUE,
Boulder, presented a youth whose right eye had been injured with shot f r o m a shot gun. Radiograms showed that one shot had passed entirely thru the eye ball, and was lodged at o r near the apex of the right orbit, probably just above
A f t e r nine
weeks the most dangerous period is past. W . H . CRISP, Denver, emphasized the importance o f considering focal infec tion in the presence o f any ocular trau matism. It was a point which was often overlooked, the traumatism being re garded as sufficient explanation o f any persistent inflammation, o r failure t o heal.
PROCEEDINGS
bruit, and the patient stated the noise on the right side o f the head had ceased. The swelling o f the lids and the p r o p tosis gradually receded, and three months following the operation, the exophthal mometer reveals recession o f the prop tosis from 1 0 to 5 mm. and the swelling of the lids reduced to almost normal. T h e patient has been comfortable since the operation. DR. T . B . HOLLOWAY stated that what was said about the orbital operation was correct at the time it was written. H e pointed out that ligation o f the c o m m o n carotid was not free from cerebral c o m plications and that the statistics o f Siegrist give an incidence o f about 8 per cent. Still further, in a few instances, ocular complications have arisen. It is true that these statistics run back f o r years and that local conditions such as infection and secondary hemorrhage are now less frequently encountered. O n the other hand, he questioned whether the observations concerning cerebral complications were as accurately re corded as those following ligation o f the orbital vein. Dr. H o l l o w a y stated that he could only repeat a previous statement to the effect, that if he should develop a pulsating e x ophthalmos he would probably prefer a slow ligation o f the c o m m o n carotid, but certainly a ligation o f the orbital vein before a ligation o f the other carotid. After all was said, a number o f factors should determine the character o f the treatment, such as the age o f the patient, the extent and character o f the injury, the associated medical conditions, and the local signs. DR. ZENTMAYER said that he thought Dr. H o l l o w a y touched o n the important point in the management o f these cases when he said that it depended somewhat on the degree o f exophthalmos and the general condition o f the patient. T h e case which he had just shown was not greatly annoyed by the bruit, the exoph thalmos is not extreme, and there is neither disfiguring Chemosis n o r redness of the conjunctiva, so that he had not strongly urged a radical procedure and the patient did not feel that she would care to submit to an operation which might prove serious.
873
Mikulicz's Disease. D R . J O H N P . O ' B R I E N exhibited a case
o f Mikulicz's disease in a colored w o man, aged 2 4 years. Examination re vealed enlarged lacrimal and parotid glands; otherwise the physical examina tion was negative. History shows no T . B . ; no miscarriages; V o n Pirquet slightly positive; Wassermann negative; urin alysis trace o f albumin; leucocytosis 1 2 , 0 0 0 ; differential normal; red cells 3,320,000;
hemoglobin
fundus negative. hygienic. Discussion.
65
per
cent;
Treatment, tonics and
DR. S.
LEWIS
ZIEGLER
stated that he had personally observed five cases o f Mikulicz's disease and had reported three cases. T h e characteristic sign o f "blood-hound faciés," to which he had called attention, was absent in this case, as the lacrimal glands alone were decidedly enlarged, but the parotids were only slightly more prominent than usual. T h e other glands were negative. H e thought it was always necessary to search f o r respiratory obstruction, and to treat it i f indicated so as to relieve the suboxidation which caused the gland ular hypertrophy. H e had found such lesions in all his cases, and had relieved two b y tonsillectomy a n d o n e b y nasal cauterization. T h e olher t w o were re ferred t o the rhinologist f o r similar treatment, but he did not know the final result. H e thought a similar examina tion in this case might reveal some o b struction to breathing that might prove to be a causative factor. C.
E . G. S H A N N O N , Clerk.
THE BROOKLYN OPHTHAL MOLOGICAL SOCIETY. APRIL
19, 1924.
Glaucoma and the Endocrins. DR.
PERCY FRIDENBERG, o f N e w Y o r k
City, read the paper elsewhere published in full in this issue, page 8 6 0 . Discussion. D R . F . BAILEY. I was in hopes D r . Fridenberg would give us some o f the results o f treatment in con nection with the endocrins. D R . D E E L E Y . — P r o f . Imre found by the tonometer a reduction in tension in preg nancy. I would like t o ask if that is
874
BROOKLYN
OPHTHALMOLOGICAL
due to excitement o f the thyroid. I n a General Hospital with obstetric service I found in fifteen cases the tension ranged from 9 to 1 8 . DR.
STEINBUGLER
H o w can w e e x
plain reduction o f tension b y atropin in cyclitis ? DR.
FRIDENBERG
In
addition to
the
late infections one danger o f the Elliot operation is that o f traumatism to an eye so delicately covered. I did not touch on simple chronic glaucoma; as some claim it is o f different origin from the inflammatory, being, perhaps, a form of optic nerve atrophy. I would rather not deal with the treatment f o r it is still too much in the experimental stage. O u r experiments according to Prof. Imre's suggestions were not satisfactory. Thyroid activity is on the side o f sym pathetic irritation and high tension. T h e pituitary is involved in pregnancy. Sympathetic paralysis means contrac tion o f pupil and l o w tension. Sym pathetic irritation means dilatation and plus tension. Herpes zoster gives plus tension, while degenerative conditions with anesthesia gave minus tension. Sometimes pilocarpin instilled in the eye does not lower the tension, whereas given by hypodermic it causes sweating and lowering o f tension. Perhaps in ocular medication it m a y be absorbed and aflrect the endocrin balance. Glau coma comes o n at a time when the pupil is normally small and more frequently in hyperopia, yet produces a dilatation of the pupil which will not contract. W h y ? W e d o not know. W.
M . GARDNER, M . D .
Secretary.
COLORADO OPHTHALMOLOG ICAL SOCIETY APRIL 1 9 , 1924. DR.
R.
SPENCER
and
C. L.
the optic nerve. There were a number o f heavy floaters in the vitreous. T h e vision o f the injured eye was 1 / 6 0 . C o l o b o m a o f Iris a n d C h o r o i d . J A M E S M . SHIELDS, D e n v e r , presented
a boy aged eleven years w h o had bilateral coloboma o f the iris associated with c o l o boma o f the choroid. T h e patient was one o f eight children. N o other member of the family had any ocular defect known to the parents, but a brother o f the mother had a similar defect. T h e iris coloboma extended to the sclera, and the notched lower edge o f each lens was clearly visible. T h e choroidal coloboma in the right eye extended a g o o d deal higher than in the left, and in the right eye the optic disc was missing, altho the retinal vessels could be seen at the normal position o f the disc. T h e vision was R . moving objects in the lower part of the field, L . 1 0 / 2 0 with a minus cor rection. I n j u r y I n v o l v i n g Ciliary B o d y . W . F . M A T S O N , Denver, again pre sented the case o f magnet extraction o f a foreign b o d y previously shown at the February, 1 9 2 4 , meeting. T h e e y e had been severely inflamed, but had become quieter after intravenous injection o f sixteen grain doses o f sodium salicylat every other day f o r several doses. There was very little vision, but the e y e was fairly quiet, altho it w o u l d be removed if any decided exacerbation occurred. Discussion. C. E . W A L K E R , Denver, suggested that on account o f the w o u n d being thru the ciliary body the eye was fikely t o get worse and it would be proper to remove it. W . C . B A N E , Denver, thought that the eye was improving and that it w o u l d be well to wait. MELVILLE BLACK, Denver.
W . A . SEDWICK, Presiding.
Gun Shot Inquiry. F.
SOCIETY
L A RUE,
Boulder, presented a youth whose right eye had been injured with shot f r o m a shot gun. Radiograms showed that one shot had passed entirely thru the eye ball, and was lodged at o r near the apex of the right orbit, probably just above
A f t e r nine
weeks the most dangerous period is past. W . H . CRISP, Denver, emphasized the importance o f considering focal infec tion in the presence o f any ocular trau matism. It was a point which was often overlooked, the traumatism being re garded as sufficient explanation o f any persistent inflammation, o r failure t o heal.