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The Pittsburgh Ophthalmological Society
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BROOKLYN OPHTHALMOLOGICAL SOCIETY
vertical axis f o r its greatest efficiency. The lines o f force f o r m a cone, the axis o f which represents the line of greatest pull. If the magnet is placed at 4 5 ° , there will not be the proper pull. T h e anterior method is useful where the incision would otherwise have to be in the region o f the ciliary body. Bring the magnet over the apex o f cornea. I f you insert your small magnet immediate ly after y o u have opened the anterior chamber, you may entangle the iris. Wait five minutes to permit partial restoration of the anterior chamber. G o o d results depend upon having the least trauma b y instruments and by the foreign body. D R . GEORGE S . D I X O N : T h e matter o f
not finding a foreign body when it is present recalls a patient X-rayed nine times, before the shadow o f a triangular piece o f metal was obtained. This was inexcusable; one attempt by the merest tyro should have been sufficient to de tect the foreign body. N o person is in fallible; but there is small excuse for not finding a steel foreign body. I have been accused o f failure in t w o cases. I am reasonably sure that one was negative, and in the second the foreign body re ported to have been removed may have entered the eye subsequent to the first examination. I think it is a mistake to pull a foreign body forward at right angle to the center of the cornea. I formerly believed it im possible to draw a foreign body thru the lens by means o f the magnet, but I saw it done. A foreign body o f about 34mm. o r less was in an eye which had a clear lens. After the magnet was ap plied the foreign body was found in the anterior chamber, and the lens showed a line thru its center streaked with blood. It is a mistake to drag a ragged foreign body thru the zonula. It is unwise to bring the eye close to the magnet f o r the first attempt to extract a large foreign body, say over 3 o r 4 m m . A n X - r a y examination should be made in all cases o f eye injury. A case in point —an eye was struck by a snowball. A cataract resulted. There was n o history o f other injury. A cataract extraction was done, but the case ran a protracted, unsatisfactory course. A n X - r a y demon strated the presence o f a piece o f metal at the fundus. T h e eye was lost.
A s u r g e o n will frequently undertake to r e m o v e a f o r e i g n b o d y , fail, a n d r e turn the patient to the W a r d ; and t h e next d a y again attempt its r e m o v a l b y r e a p p l y i n g the m a g n e t . Relocalization should b e d o n e . I b e l i e v e it un wise to use the posterior route in an eye Avhich has been e x p o s e d t o t h e m a g n e t w i t h o u t another l o c a l i z a t i o n . DR.
OHLY:
In
reference
to
Dr.
L l o y d ' s question, I c a n n o t c o n c e i v e a small particle in the e y e b e c o m i n g pol arized. It must b e d u e to the m a g n e t w h e n this o c c u r s . I a m v e r y m u c h in terested in the e g g albumen experi ment, but I do not know if these con ditions are the same in the v i t r e o u s . I certainly agreed with D r . D i x o n . If I have attempted to extract by the an terior route, then before entering the vitreous, I a l w a y s have a relocalization done. W I L L I S M . GARDNER,
Secretary. THE PITTSBURGH OPHTHAL MOLOGICAL SOCIETY. M A Y 14, 1923. D R . EDWARD B . HECKEL,
Presiding.
A t the invitation o f D r . J. B . M c Murray, the m e e t i n g w a s held at his office in W a s h i n g t o n , Pa. B y v o t e of the S o c i e t y , the scientific part o f t h e m e e t i n g w a s given o v e r to D r . M c M u r ray for the presentation o f clinical cases. A f t e r the m e e t i n g . D r . M c M u r ray entertained the S o c i e t y at dinner at the G e o r g e W a s h i n g t o n H o t e l . Anterior Brain Tumor. D R . I. B . McMuRRAY presented the following: S. W . , female, aged 4 3 . H a d a l w a y s e n j o y e d g o o d health. W a s struck d o w n b y an a u t o m o b i l e t w o years a g o ; w a s u n c o n s c i o u s for a short period, but r e c o v e r e d and w a s w e l l un til six w e e k s prior t o first visit t o the office. A t that time, she c o m p l a i n e d of severe neuralgic pain in right side o f the face, general w e a k n e s s and malaise. E x a m i n a t i o n o f the e y e s s h o w e d she had a congenital alternating divergent squint. V i s i o n in each e y e w a s 6 / 4 . Cornea, anterior c h a m b e r , iris, lens, media and fundus w e r e found n e g a t i v e
SOCIETY PROCEEDINGS
in eacli e y e . Repeated examination d u r i n g the six w e e k s f o u n d fundi n e g a tive. D u r i n g the last t w o w e e k s she w a s in the hospital, a d i a g n o s i s of an terior cerebral brain t u m o r w a s m a d e , the diagnosis b e i n g based o n the ab sence of focal s y m p t o m s and the de v e l o p m e n t o f vesical and rectal i n c o n tinence. T w o days prior to death, pa-
Fiji. 1.
225
g o to the hospital, but w a s not admit ted until N o v e m b e r 11th, 1922, at which time the optic discs were much s w o l l e n and the fields contracted; vision r e d u c e d in right e y e to 6 / 1 2 and in left e y e to 6 / 1 5 . T h e headache at that time w a s quite severe and relieved o n l y b y spinal puncture. Spinal fluid w a s u n d e r pressure and w a s negative
Remaining fields of vision in tumor of anterior 'brain. Ophthalmoscopic examination negative until two days before death.
tient d e v e l o p e d a l o w g r a d e papillitis. A u t o p s y s h o w e d a large t u m o r in the anterior lobe. F r o m a symptomatic standpoint, the e y e remained negative until t w o d a y s prior to death. Posterior Brain Timior. K . T., female, a g e d 19. O n O c t o b e r 7th, 1922, she c a m e c o m p l a i n i n g of headache and blurring of print. She had s o m e headache all s u m m e r before, but n o t e n o u g h pain to a n n o y her m u c h . V i s i o n at that time in the right eye w a s 6 / 6 , left eye 6 / 4 . W i t h c o r r e c tion of plus 1.75 sphere, c o m b i n e d with plus 0.50 D . c y . ax. 9 0 ° , vision in each eye w a s 6 / 4 . N o fundus c h a n g e s w e r e found at that time. O c t o b e r 24th, 1922, she w a s again e x a m i n e d because of continued headaches. Examination s h o w e d b e g i n n i n g e d e m a of the retina surrounding the discs, with blurring of e d g e s o f discs. She w a s advised t o
to W a s s e r m a n n . Cell c o u n t w a s nor mal. Swelling o f the discs increased, until D e c e m b e r 14th, 1922, w h e n a de c o m p r e s s i o n w a s d o n e in the right t e m p o r a l r e g i o n , in the h o p e of p o s t p o n i n g any further i n v o l v e m e n t of the o p t i c nerve. T h e h e a d a c h e , v o m i t i n g and dizziness w e r e r e l i e v e d ; vision has remained stationary. Six m o n t h s later, patient still has e n o u g h vision to g o about alone. Brain Tumor. F e m a l e , aged about 17. She c a m e for s e v e r e h e a d a c h e and failing v i s i o n . In the S p r i n g of 1921, vision b e c a m e so bad that she had to discontinue s c h o o l w o r k . H a d a l w a y s been very hyper o p i c , but with c o r r e c t i o n had vision of 6 / 6 in each e y e . In S p r i n g of 1921, vision w a s reduced to 6 / 2 0 in each eye. There was no change in the discs and n o t h i n g of i m p o r t a n c e in the fields.
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H e a d a c h e s c o u l d not b e relieved. In the winter of 1922, h e a d a c h e s b e c a m e severe. X - r a y plates of head s h o w e d cloudiness o v e r right frontal. The frontal sinus r e g i o n w a s o p e n e d and the sinus f o u n d absent, but f o l l o w i n g this operation, patient had relief from headache f o r a c o u p l e of w e e k s . A sec o n d operation w a s d o n e to relieve w h a t w a s t h o u g h t m i g h t be an abscess in the frontal region. A g a i n pain w a s re lieved, but n o abscess found. The slight l o w e r i n g of pressure e v i d e n t l y w a s the cause o f the relief. A t n o time was there any change in the disc. T h e patient recently has been s o sick that n o fields c o u l d b e taken. H e r vision re mains p o o r , but d o e s not seem to b e failing. Since presenting this case, the d i a g n o s i s has been c h a n g e d from brain abscess to brain t u m o r , p r o b a b l y l o cated near the floor of the fourth v e n tricle, with pressure on the o p t i c nerves near their origin, w h i c h p r o b ably a c c o u n t s for the failing vision, the lack of fundus findings and the p e culiar fields, a chart of w h i c h is at tached. Patient has had t w o t e m p o r a l d e c o m p r e s s i o n s and at the present t i m e is free from pain, vision not i m p r o v e d , fundus c o n d i t i o n apparently n o r m a l . Detachment of Retina. G. M . , male, a g e d 19. O n July 8th, 1922, patient c a m e c o m p l a i n i n g of pain in right eye, w h i c h had b e g u n the pre c e d i n g A p r i l . O n entering s c h o o l , the s c h o o l e x a m i n e r reported he had nor mal vision in each eye. Patient played football during the fall and basketball during the winter. Examination s h o w e d fluid vitreous, w i t h floating opacities and an extensive retinal de tachment, well f o r w a r d and e x t e n d i n g well up on the temporal side and on the nasal side. T r a n s i l l u m i n a t i o n did not s u g g e s t n e o p l a s m . T h i s is evi dently a case of traumatic d e t a c h m e n t of the retina. Congenital Subluxation of Lens. F e m a l e , a g e d about 30. C a m e for headaches and nausea after c l o s e w o r k . H a s w o r n glasses six y e a r s ; last c h a n g e three years a g o . Awakens w i t h pain in the head, w h i c h usually gets better d u r i n g the day. Has
nausea after reading, beginning in about -ten minutes, and if she continues to read will vomit. Vision without cor rection is O . D . , 2 / 6 0 ; O.S., hand move ments. T h e right lens is d i s l o c a t e d outward. W i t h c o r r e c t i o n of m i n u s 7.00 D . , vision in right e y e is i m p r o v e d to 6 / 3 0 . Osteoma of Orbit. Male, a g e d 32. In 1917, w a s struck in left e y e w i t h a h a m m e r . S o m e w e e k s afterward n o t i c e d e y e w a s b e c o m i n g prominent. This was not accompanied w i t h any pain, but vision w a s d o u b l e o c c a s i o n a l l y . A t that time, he had n o demonstrable diplopia, or any evi d e n c e of muscular i m b a l a n c e . Palpa tion s h o w e d a hard mass, b e g i n n i n g just b a c k of the lacrimal g r o o v e and e x t e n d i n g into the orbit. T h e nose revealed nothing, e x c e p t it w a s v e r y n a r r o w in the upper straits. Patient w a s kept under o b s e r v a t i o n and in Jan., 1917, w a s presented before the Pittsburgh O p h t h a l m o l o g i c a l S o c i e t y , w h e r e the s u g g e s t i o n w a s m a d e that the mass m i g h t be a m u c o c e l e , altho on palpation it s e e m e d t o o hard. In Feb., 1919, f o l l o w i n g t w o rather acute attacks of pain in the left frontal re g i o n , an o p e r a t i o n w a s advised. A Killian incision w a s m a d e and the in ner wall of the orbit e x p o s e d . The frontal sinus w a s o p e n e d a b o v e the or bital r i d g e and f o u n d full o f pus and m u c o i d secretion. A n attempt w a s made to pass a p r o b e into the n o s e , thru the nasal duct, and found i m p o s sible. A n e x o s t o s i s , originating in the ethmoid, of i v o r y hardness, and e x t e n d ing into the orbit, b l o c k e d the normal drainage from the frontal sinus. D r a i n age of the left frontal sinus w a s m a d e into the right nostril and remains open to this day. A t the present time, the e y e is m u c h m o r e p r o m i n e n t than it w a s four years a g o , but the patient d o e s n o t h a v e any diplopia. T h e case is presented t o show this interesting condition, that is, the m a r k e d p r o p t o s i s , w i t h n o d i p l o p i a . T h e patient has persistent fistula un der the left frontal. E n t r a n c e i n t o the nose is i m p o s s i b l e on a c c o u n t o f the extent and hardness o f the o s t e o m a .
SOCIETY
PROCEEDINGS
Degeneration of Globe Following Con tusion.
227
Mucocele of Ethmoid with Proptosis of Right Eye.
Male, aged about 1 5 , c a m e for blind D R . R I C H A R D L . B A U E R d e s c r i b e d the ness in right e y e . L a s t basketball a b o v e case and presented the patient. season, w a s hit in the right eye with a T h e case is published p . 2 1 8 of this basketball. T h i n k s vision w a s effected Journal. immediately after the injury. Five Medullated Nerve Fibers in the Retina. w e e k s a g o , w a s struck in the right eye D R . CLARENCE LOEB p r e s e n t e d a c o l with t h e palm o f a f e l l o w p l a y e r ' s hand. ored d r a w i n g o f this c o n d i t i o n , the H a s h a d s o m e pain for a c o u p l e o f w o r k of a y o u n g artist in the M i c h a e l days. Examination shows redness R e e s e D i s p e n s a r y , E y e Clinic. ( F i g . around the cornea, anterior c h a m b e r 1·) shallow, lens entirely o p a q u e , tension normal. L i g h t perception n o t g o o d , Congenital Ptosis Corrected by the consensual reflex p r o m p t , but direct Hunt-Tansley Operation. very sluggish. Transillumination D R . CLARENCE LOEB p r e s e n t e d this s h o w s iris atrophied thruout the entire case. ( S e e p . 2 1 6 ) . extent with the e x c e p t i o n o f a little Synechia of the Vitreous to the Cor place at the upper e x t r e m i t y of t h e 9 0 ° nea. line. Patient has u n d o u b t e d l y had, in D R . H . M . COTTLE ( b y i n v i t a t i o n ) addition t o the detached retina at the read a paper on the above condition. time o f the injury, a subsequent intra ocular inflammation t o a c c o u n t for the ( T o be published in this j o u r n a l ) . degenerative c h a n g e s o c c u r r i n g later. Atypical Parenchymatous Keratitis. Male, aged 7 . Left eye had a spot on it. Mother noticed eye getting white o v e r a year a g o . S h e thinks spot dis appears at times, but this is doubtful. R i g h t e y e , vision 2 0 / 2 0 . Left e y e , 20/100. E x a m i n a t i o n s h o w s a very dense, whitish infiltrated area, center of left c o r n e a . T h e infiltrated areas are not c o a l e s c e d b u t appear in five areas rather c l o s e l y placed in center of c o r nea. T h e y are quite d e e p in the sub stance of the cornea. T h e r e is s o m e new vessel formation from the c o r neoscleral margin. T h e patient has n o t c h e d teeth. N o W a s s e r m a n n m a d e . GEORGE H . S H U M A N , M . D . , SECRETARY.
CHICAGO OPHTHALMOLOGICAL SOCIETY. Monday, October 2 2 , 1923. D R . ROBERT λ^οΝ D E R Ι Ι Ε Ί Π Τ , P r e s i d i n g .
Gumma in Orbit. D R . G . F . SUKKR desc\-ibed the find ings in three cases o f intraorbital gum ma with o]itic nerve i n v o l v e m e n t , and anmdar g u m m a of the conjunctiva, b u t the patients did n o t report at the m e e t ing.
Fig. 1. Case of medullated nerve fibers in the rttina. Discussion.
D R . ROBERT
VON
DER
HEYDT stated that V o g t has found that these adhesions nearly a l w a y s f o l l o w discission. H o w e v e r , this m a y b e true o n l y if the v i t r e o u s is semifluid in na ture. A q u e o u s and vitreous are v e r y c o m p a t i b l e in the anterior c h a m b e r o f an aphakic eyes. W i t h the slit lamp, it is \ e r y easy to determine the consistency of the vitreous in the presence o f a fair ly transparent lens. B y means o f our f)lder methods, this is possible only if vit reous opacities are present, as they b e tray the fluidity o f the vitreous by their movements.
BROOKLYN OPHTHALMOLOGICAL SOCIETY
vertical axis f o r its greatest efficiency. The lines o f force f o r m a cone, the axis o f which represents the line of greatest pull. If the magnet is placed at 4 5 ° , there will not be the proper pull. T h e anterior method is useful where the incision would otherwise have to be in the region o f the ciliary body. Bring the magnet over the apex o f cornea. I f you insert your small magnet immediate ly after y o u have opened the anterior chamber, you may entangle the iris. Wait five minutes to permit partial restoration of the anterior chamber. G o o d results depend upon having the least trauma b y instruments and by the foreign body. D R . GEORGE S . D I X O N : T h e matter o f
not finding a foreign body when it is present recalls a patient X-rayed nine times, before the shadow o f a triangular piece o f metal was obtained. This was inexcusable; one attempt by the merest tyro should have been sufficient to de tect the foreign body. N o person is in fallible; but there is small excuse for not finding a steel foreign body. I have been accused o f failure in t w o cases. I am reasonably sure that one was negative, and in the second the foreign body re ported to have been removed may have entered the eye subsequent to the first examination. I think it is a mistake to pull a foreign body forward at right angle to the center of the cornea. I formerly believed it im possible to draw a foreign body thru the lens by means o f the magnet, but I saw it done. A foreign body o f about 34mm. o r less was in an eye which had a clear lens. After the magnet was ap plied the foreign body was found in the anterior chamber, and the lens showed a line thru its center streaked with blood. It is a mistake to drag a ragged foreign body thru the zonula. It is unwise to bring the eye close to the magnet f o r the first attempt to extract a large foreign body, say over 3 o r 4 m m . A n X - r a y examination should be made in all cases o f eye injury. A case in point —an eye was struck by a snowball. A cataract resulted. There was n o history o f other injury. A cataract extraction was done, but the case ran a protracted, unsatisfactory course. A n X - r a y demon strated the presence o f a piece o f metal at the fundus. T h e eye was lost.
A s u r g e o n will frequently undertake to r e m o v e a f o r e i g n b o d y , fail, a n d r e turn the patient to the W a r d ; and t h e next d a y again attempt its r e m o v a l b y r e a p p l y i n g the m a g n e t . Relocalization should b e d o n e . I b e l i e v e it un wise to use the posterior route in an eye Avhich has been e x p o s e d t o t h e m a g n e t w i t h o u t another l o c a l i z a t i o n . DR.
OHLY:
In
reference
to
Dr.
L l o y d ' s question, I c a n n o t c o n c e i v e a small particle in the e y e b e c o m i n g pol arized. It must b e d u e to the m a g n e t w h e n this o c c u r s . I a m v e r y m u c h in terested in the e g g albumen experi ment, but I do not know if these con ditions are the same in the v i t r e o u s . I certainly agreed with D r . D i x o n . If I have attempted to extract by the an terior route, then before entering the vitreous, I a l w a y s have a relocalization done. W I L L I S M . GARDNER,
Secretary. THE PITTSBURGH OPHTHAL MOLOGICAL SOCIETY. M A Y 14, 1923. D R . EDWARD B . HECKEL,
Presiding.
A t the invitation o f D r . J. B . M c Murray, the m e e t i n g w a s held at his office in W a s h i n g t o n , Pa. B y v o t e of the S o c i e t y , the scientific part o f t h e m e e t i n g w a s given o v e r to D r . M c M u r ray for the presentation o f clinical cases. A f t e r the m e e t i n g . D r . M c M u r ray entertained the S o c i e t y at dinner at the G e o r g e W a s h i n g t o n H o t e l . Anterior Brain Tumor. D R . I. B . McMuRRAY presented the following: S. W . , female, aged 4 3 . H a d a l w a y s e n j o y e d g o o d health. W a s struck d o w n b y an a u t o m o b i l e t w o years a g o ; w a s u n c o n s c i o u s for a short period, but r e c o v e r e d and w a s w e l l un til six w e e k s prior t o first visit t o the office. A t that time, she c o m p l a i n e d of severe neuralgic pain in right side o f the face, general w e a k n e s s and malaise. E x a m i n a t i o n o f the e y e s s h o w e d she had a congenital alternating divergent squint. V i s i o n in each e y e w a s 6 / 4 . Cornea, anterior c h a m b e r , iris, lens, media and fundus w e r e found n e g a t i v e
SOCIETY PROCEEDINGS
in eacli e y e . Repeated examination d u r i n g the six w e e k s f o u n d fundi n e g a tive. D u r i n g the last t w o w e e k s she w a s in the hospital, a d i a g n o s i s of an terior cerebral brain t u m o r w a s m a d e , the diagnosis b e i n g based o n the ab sence of focal s y m p t o m s and the de v e l o p m e n t o f vesical and rectal i n c o n tinence. T w o days prior to death, pa-
Fiji. 1.
225
g o to the hospital, but w a s not admit ted until N o v e m b e r 11th, 1922, at which time the optic discs were much s w o l l e n and the fields contracted; vision r e d u c e d in right e y e to 6 / 1 2 and in left e y e to 6 / 1 5 . T h e headache at that time w a s quite severe and relieved o n l y b y spinal puncture. Spinal fluid w a s u n d e r pressure and w a s negative
Remaining fields of vision in tumor of anterior 'brain. Ophthalmoscopic examination negative until two days before death.
tient d e v e l o p e d a l o w g r a d e papillitis. A u t o p s y s h o w e d a large t u m o r in the anterior lobe. F r o m a symptomatic standpoint, the e y e remained negative until t w o d a y s prior to death. Posterior Brain Timior. K . T., female, a g e d 19. O n O c t o b e r 7th, 1922, she c a m e c o m p l a i n i n g of headache and blurring of print. She had s o m e headache all s u m m e r before, but n o t e n o u g h pain to a n n o y her m u c h . V i s i o n at that time in the right eye w a s 6 / 6 , left eye 6 / 4 . W i t h c o r r e c tion of plus 1.75 sphere, c o m b i n e d with plus 0.50 D . c y . ax. 9 0 ° , vision in each eye w a s 6 / 4 . N o fundus c h a n g e s w e r e found at that time. O c t o b e r 24th, 1922, she w a s again e x a m i n e d because of continued headaches. Examination s h o w e d b e g i n n i n g e d e m a of the retina surrounding the discs, with blurring of e d g e s o f discs. She w a s advised t o
to W a s s e r m a n n . Cell c o u n t w a s nor mal. Swelling o f the discs increased, until D e c e m b e r 14th, 1922, w h e n a de c o m p r e s s i o n w a s d o n e in the right t e m p o r a l r e g i o n , in the h o p e of p o s t p o n i n g any further i n v o l v e m e n t of the o p t i c nerve. T h e h e a d a c h e , v o m i t i n g and dizziness w e r e r e l i e v e d ; vision has remained stationary. Six m o n t h s later, patient still has e n o u g h vision to g o about alone. Brain Tumor. F e m a l e , aged about 17. She c a m e for s e v e r e h e a d a c h e and failing v i s i o n . In the S p r i n g of 1921, vision b e c a m e so bad that she had to discontinue s c h o o l w o r k . H a d a l w a y s been very hyper o p i c , but with c o r r e c t i o n had vision of 6 / 6 in each e y e . In S p r i n g of 1921, vision w a s reduced to 6 / 2 0 in each eye. There was no change in the discs and n o t h i n g of i m p o r t a n c e in the fields.
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PITTSBURGH OPHTHALMOLOGICAL SOCIETY
H e a d a c h e s c o u l d not b e relieved. In the winter of 1922, h e a d a c h e s b e c a m e severe. X - r a y plates of head s h o w e d cloudiness o v e r right frontal. The frontal sinus r e g i o n w a s o p e n e d and the sinus f o u n d absent, but f o l l o w i n g this operation, patient had relief from headache f o r a c o u p l e of w e e k s . A sec o n d operation w a s d o n e to relieve w h a t w a s t h o u g h t m i g h t be an abscess in the frontal region. A g a i n pain w a s re lieved, but n o abscess found. The slight l o w e r i n g of pressure e v i d e n t l y w a s the cause o f the relief. A t n o time was there any change in the disc. T h e patient recently has been s o sick that n o fields c o u l d b e taken. H e r vision re mains p o o r , but d o e s not seem to b e failing. Since presenting this case, the d i a g n o s i s has been c h a n g e d from brain abscess to brain t u m o r , p r o b a b l y l o cated near the floor of the fourth v e n tricle, with pressure on the o p t i c nerves near their origin, w h i c h p r o b ably a c c o u n t s for the failing vision, the lack of fundus findings and the p e culiar fields, a chart of w h i c h is at tached. Patient has had t w o t e m p o r a l d e c o m p r e s s i o n s and at the present t i m e is free from pain, vision not i m p r o v e d , fundus c o n d i t i o n apparently n o r m a l . Detachment of Retina. G. M . , male, a g e d 19. O n July 8th, 1922, patient c a m e c o m p l a i n i n g of pain in right eye, w h i c h had b e g u n the pre c e d i n g A p r i l . O n entering s c h o o l , the s c h o o l e x a m i n e r reported he had nor mal vision in each eye. Patient played football during the fall and basketball during the winter. Examination s h o w e d fluid vitreous, w i t h floating opacities and an extensive retinal de tachment, well f o r w a r d and e x t e n d i n g well up on the temporal side and on the nasal side. T r a n s i l l u m i n a t i o n did not s u g g e s t n e o p l a s m . T h i s is evi dently a case of traumatic d e t a c h m e n t of the retina. Congenital Subluxation of Lens. F e m a l e , a g e d about 30. C a m e for headaches and nausea after c l o s e w o r k . H a s w o r n glasses six y e a r s ; last c h a n g e three years a g o . Awakens w i t h pain in the head, w h i c h usually gets better d u r i n g the day. Has
nausea after reading, beginning in about -ten minutes, and if she continues to read will vomit. Vision without cor rection is O . D . , 2 / 6 0 ; O.S., hand move ments. T h e right lens is d i s l o c a t e d outward. W i t h c o r r e c t i o n of m i n u s 7.00 D . , vision in right e y e is i m p r o v e d to 6 / 3 0 . Osteoma of Orbit. Male, a g e d 32. In 1917, w a s struck in left e y e w i t h a h a m m e r . S o m e w e e k s afterward n o t i c e d e y e w a s b e c o m i n g prominent. This was not accompanied w i t h any pain, but vision w a s d o u b l e o c c a s i o n a l l y . A t that time, he had n o demonstrable diplopia, or any evi d e n c e of muscular i m b a l a n c e . Palpa tion s h o w e d a hard mass, b e g i n n i n g just b a c k of the lacrimal g r o o v e and e x t e n d i n g into the orbit. T h e nose revealed nothing, e x c e p t it w a s v e r y n a r r o w in the upper straits. Patient w a s kept under o b s e r v a t i o n and in Jan., 1917, w a s presented before the Pittsburgh O p h t h a l m o l o g i c a l S o c i e t y , w h e r e the s u g g e s t i o n w a s m a d e that the mass m i g h t be a m u c o c e l e , altho on palpation it s e e m e d t o o hard. In Feb., 1919, f o l l o w i n g t w o rather acute attacks of pain in the left frontal re g i o n , an o p e r a t i o n w a s advised. A Killian incision w a s m a d e and the in ner wall of the orbit e x p o s e d . The frontal sinus w a s o p e n e d a b o v e the or bital r i d g e and f o u n d full o f pus and m u c o i d secretion. A n attempt w a s made to pass a p r o b e into the n o s e , thru the nasal duct, and found i m p o s sible. A n e x o s t o s i s , originating in the ethmoid, of i v o r y hardness, and e x t e n d ing into the orbit, b l o c k e d the normal drainage from the frontal sinus. D r a i n age of the left frontal sinus w a s m a d e into the right nostril and remains open to this day. A t the present time, the e y e is m u c h m o r e p r o m i n e n t than it w a s four years a g o , but the patient d o e s n o t h a v e any diplopia. T h e case is presented t o show this interesting condition, that is, the m a r k e d p r o p t o s i s , w i t h n o d i p l o p i a . T h e patient has persistent fistula un der the left frontal. E n t r a n c e i n t o the nose is i m p o s s i b l e on a c c o u n t o f the extent and hardness o f the o s t e o m a .
SOCIETY
PROCEEDINGS
Degeneration of Globe Following Con tusion.
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Mucocele of Ethmoid with Proptosis of Right Eye.
Male, aged about 1 5 , c a m e for blind D R . R I C H A R D L . B A U E R d e s c r i b e d the ness in right e y e . L a s t basketball a b o v e case and presented the patient. season, w a s hit in the right eye with a T h e case is published p . 2 1 8 of this basketball. T h i n k s vision w a s effected Journal. immediately after the injury. Five Medullated Nerve Fibers in the Retina. w e e k s a g o , w a s struck in the right eye D R . CLARENCE LOEB p r e s e n t e d a c o l with t h e palm o f a f e l l o w p l a y e r ' s hand. ored d r a w i n g o f this c o n d i t i o n , the H a s h a d s o m e pain for a c o u p l e o f w o r k of a y o u n g artist in the M i c h a e l days. Examination shows redness R e e s e D i s p e n s a r y , E y e Clinic. ( F i g . around the cornea, anterior c h a m b e r 1·) shallow, lens entirely o p a q u e , tension normal. L i g h t perception n o t g o o d , Congenital Ptosis Corrected by the consensual reflex p r o m p t , but direct Hunt-Tansley Operation. very sluggish. Transillumination D R . CLARENCE LOEB p r e s e n t e d this s h o w s iris atrophied thruout the entire case. ( S e e p . 2 1 6 ) . extent with the e x c e p t i o n o f a little Synechia of the Vitreous to the Cor place at the upper e x t r e m i t y of t h e 9 0 ° nea. line. Patient has u n d o u b t e d l y had, in D R . H . M . COTTLE ( b y i n v i t a t i o n ) addition t o the detached retina at the read a paper on the above condition. time o f the injury, a subsequent intra ocular inflammation t o a c c o u n t for the ( T o be published in this j o u r n a l ) . degenerative c h a n g e s o c c u r r i n g later. Atypical Parenchymatous Keratitis. Male, aged 7 . Left eye had a spot on it. Mother noticed eye getting white o v e r a year a g o . S h e thinks spot dis appears at times, but this is doubtful. R i g h t e y e , vision 2 0 / 2 0 . Left e y e , 20/100. E x a m i n a t i o n s h o w s a very dense, whitish infiltrated area, center of left c o r n e a . T h e infiltrated areas are not c o a l e s c e d b u t appear in five areas rather c l o s e l y placed in center of c o r nea. T h e y are quite d e e p in the sub stance of the cornea. T h e r e is s o m e new vessel formation from the c o r neoscleral margin. T h e patient has n o t c h e d teeth. N o W a s s e r m a n n m a d e . GEORGE H . S H U M A N , M . D . , SECRETARY.
CHICAGO OPHTHALMOLOGICAL SOCIETY. Monday, October 2 2 , 1923. D R . ROBERT λ^οΝ D E R Ι Ι Ε Ί Π Τ , P r e s i d i n g .
Gumma in Orbit. D R . G . F . SUKKR desc\-ibed the find ings in three cases o f intraorbital gum ma with o]itic nerve i n v o l v e m e n t , and anmdar g u m m a of the conjunctiva, b u t the patients did n o t report at the m e e t ing.
Fig. 1. Case of medullated nerve fibers in the rttina. Discussion.
D R . ROBERT
VON
DER
HEYDT stated that V o g t has found that these adhesions nearly a l w a y s f o l l o w discission. H o w e v e r , this m a y b e true o n l y if the v i t r e o u s is semifluid in na ture. A q u e o u s and vitreous are v e r y c o m p a t i b l e in the anterior c h a m b e r o f an aphakic eyes. W i t h the slit lamp, it is \ e r y easy to determine the consistency of the vitreous in the presence o f a fair ly transparent lens. B y means o f our f)lder methods, this is possible only if vit reous opacities are present, as they b e tray the fluidity o f the vitreous by their movements.