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ment, from the location and character of the pain.

Dr. Jackson considered involvement of the maxillary sinus
probable, with extension of hyperemia to the margin of the
orbit, thus affecting the lower cul-de-sac.

Dr. Bane had found no exudate in the sinuses of his pa-
tient ; he attributed the pain to the intensity of the ocular dis-
turbance, and questioned if the condition w^as not trachoma of
the lower cul-de-sac.



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SOCIETY PROCEEDINGS. 675

Central Guttate Chorioiditis.

Dr. Bane also presented a woman of 48, with a history of
hay fever for two summers. The vision of the right eye was
4/4 — and of the left 4/15 +. The vision had been dim for
six months. There had been no aching of the eyes or head.
The urine showed a specific gravity of 1010, with absence of
albumin or sugar. The right eye showed small whitish deposits
in the macular region, and in the left eye this condition was
similarly located, but much more widespread, covering an area
of 3 disk diameters. Dr. Bane had seen the same condition in
persons of 60 and 70 years, respectively; the vision in both
cases being below normal. He considered that all three cases
belonged to the above classification, as pictured by Nettleship
in his "Diseases of the Eye."

Discussion, — Dr. Patterson referred to a case history he had
reported, showing similar retinal changes, under the title:
"Notes Illustrating the Progress of a Retinitis of Presumable
Rheumatic Origin" (Ophthalmic Record, April, 1907). He
also mentioned another case that had previously presented a
normal macula, but in which changes were now visible along
the superior temporal artery, vision was only yi, and the color
field suggested degenerative changes.

Dr. Jackson had seen whitish spots in renal or circinate
retinitis, only; but had observed yellow spots with normal
vision. He would suspect high blood pressure in Dr. Bane's
case, from the narrow veins.

Obstruction of Retinal Arterf.

Dr. Jackson reported the case of a woman of 25, giving a
history of temporary obscurations of vision, prior to an attack
eleven months ago in which the right eye became entirely
blind for a few minutes. Then vision returned for objects in
the lower half of the field, but was permanently lost in the
upper half. The inferior branch of the central retinal artery
was about the diameter of the superior branch. The retina
below the macula looked slightly pale, with several whitish
dots scattered through it, and one black pigment patch con-
nected with a small arterial branch. The field of vision was
normal in the lower half. The upper portion was slightly
narrowed concentrically, and presented an absolute scotoma a
little above the fixation point, and gradually faded out to



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676 SOCIETY PROCEEDINGS.

almost normal vision toward the periphery of the field. A
small cilio-retinal artery ran to the macula. Central vision
with correction equaled 4/4. Left eye normal.

Removal of Steel in Vitreous.

Dr. E. W. Stevens reported a man of 36, in w^hom a splinter
of steel had penetrated the cornea and lens, and lodged in the
center of the vitreous. An X-ray picture, taken by Dr. S. B.
Childs, located the foreign body. It was removed by a mag-
net, through the section usually made in the upper part of the
cornea in removal of cataract. Pain, which resulted from
swelling of the lens, was relieved by cold applications and
blisters on the temples. The lens had protruded through the
pupil, but was now receding and absorbing. The case was
doing well. Later the lens would be extracted.

Dr. Stevens stated that he always had an X-ray photograph
taken in cases of probable steel particle in the eye.

orbital Cellulitis.

Dr. Stevens also reported the case history of a woman of
18 with severe orbital cellulitis of the right eye and a tem-
perature of 101 ^ to 104°, that followed influenza. All the
muscles of the right eye were paralyzed, but the media was
clear, fundus normal, and vision good. There was marked
chemosis of the conjunctiva, the lids were swollen and the eye
was ppoptosed. In 24 hours the left superior and external recti
muscles were paralyzed. The right ethmoidal and sphenoidal
cells were removed, liberating pus, and the orbit was drained
by an incision, aided by gauze. On the following day the
temperature was normal. The swelling quickly subsided and
the paralysis and exophthalmos disappeared. Dr. Stevens said
that the case had seemed typically one of sinus thrombosis.

Discussion. — Dr. Patterson related a case in which drain-
age of pus from the orbit into the antrum, and thence into the
nose, had brought relief.

Orbital Infiltration.

Dr. Bane reported the case history of a youth whose right
eye had been struck by a skate, 12 years before, cutting the
lid and globe. Enucleation was promptly done. Because of



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SOCIETY PROCEEDINGS. 677

the injured lid an artificial eye was hard to fit. The same
eye had been worn 12 years. An infiltration of the orbit, re-
sembling sarcoma, resulted. This mass was removed. Path-
ologic examination of the growth was made by Dr. J. C. Todd,
who pronounced it composed of chronic inflammatory tissue.
The artificial eye was devoid of its glossy coating and was
rather rough.

King Abscess of Cornea.

Dr. J. A. Patterson read a paper describing a case of pe-
ripheral annular infiltration of the cornea of an adult, which
followed pneumonia and was coincident with herpes febrilis
of the upper lip and lower eyelid. The article will be pub-
lished in full elsewhere.

Discussion. — Dr. Ringle considered that a degenerated cor-
nea was very vulnerable to infection, as were also herpetic
eruptions. He had a similar case under treatment for ulcer
of the cornea, with hypopyon and herpetic eruption, which was
still in a critical state.

Dr. Jackson had an impression that ring abscess was a re-
action to severe infection involving the whole cornea; all
within the ring sloughing because choked off.

Dr. Stevens mentioned the case of an otherwise healthy
woman, who had suflFered from dendritic corneal ulcer follow-
ing an herpetic bleb on the lower lid.

Meeting of April 16th, 1910, in Denver. Dr. E. W. Stevens
presiding.

liacerated Wound of Cornea and Iris.

Dr. A. C. Magruder presented a man who had received a
ragged wound of the right cornea and iris from an exploding
oil gauge, August 13th, 1909. The iris was entangled in the
corneal .wound, and the lens was slightly opaque. Some of
the iris was excised. The part entangled in the corneal wound
below was liberated on the day of injury ; that above resisted
two attempts at liberation. At no time was glass discovered
within the globe. The injured eye was now quiet, and its
fellow had shown no sympathetic irritation. Cataract and
both anterior and posterior synechia had resulted. The ques-
tions of a foreign body in the eye and subsequent probable be-
havior and treatment of the eye, were raised.



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078 SOCIETY PROCEEDINGS.

Discussion. — Dr. Black had long considered penetrating
ocular injuries from exploding oil or water gauges relatively
less dangerous than those from other foreign bodies, as the
glass was sterilized by the heat. In Dr. Magruder's case he
thought the good healing indicative of the absence of glass
within the globe. If the eye became troublesome later he
would remove it.

Descemetitis.

Dr. E. T. Boyd showed an adult who had made a good re-
covery from a recent plastic iritis, under salicylates and atro-
pin. There had been abundant deposits on Descemet's mem-
brane. These had now disappeared, w^ith the exception of a
few minute, distinct but scattered points of exudate.

Opacities of Lens and Vitreous, Associated With Myopia.

Dr. G. F. Libby showed a man of sixty-three, whose vision
in both eyes had noticeably failed in the past four years. He
had worn concave lenses since twenty years pf age. In the
past six years — 6.50 spherical in the right and — 8.00 in the
left had been satisfactory for general use. Three months ago
an optician gave — 10.50 in the right and — 13.00 in the left,
which now gave the best vision obtainable, 4/30 in each eye.
A posterior polar cataract and a diffuse nuclear haze was ob-
served in each lens, and each vitreous was so obscured by
floating opacities and general cloudiness that no fundus details
were visible. Dr. Libby stated that the only possible hope ox
ocular improvement he could see lay in the detection of errors
of elimination, circulation, or possibly an old specific infec-
tion; and that he should refer the patient to an internist for
investigations along those lines.

Discussion. — Dr. Bane noted the swelling of the lenses.

Dr. Neeper thought the hyalitis accounted largely for the
poor vision.

Dr. Hess suggested that this was a good case for extraction
of the lens in the capsule.

Pigmentation of Disk and Blindness Following Brain Lesion.

Dr. W. C. Bane presented a woman who had been affected
by right hemiplegia, inability to express ideas, and by sudden
loss of vision of the left eye, the previous August. Marked
choked disks and tortuous retinal vessels supervened. The
right eye recovered, but not the left. The paralysis gradually



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SOCIETY PROCEEDINGS. 079

disappeared, but it was still difficult to get the correct word to
express her thoughts. For a time the left radial pulse was
not palpable. Degenerative changes in the left eye had finally
resulted in a general pigmentation of the nerve head. The
diagnosis was given as gumma of the left side of the brain.
Treatment: Mercury by inunction and potassium iodid, 45
grains t. i. d.

Discussion, — Dr. Stevens called attention to Victor Hors-
ley's recent paper, which located the optic neuritis on the side
of the brain lesion ; or, in case of both disks being swollen, the
nerve on the side of the cerebral injury would finally show
the more marked degenerative changes.

Tabetic Optic Atrophy.

Dr. E. W. Stevens showed an adult with gray atrophy of
both optic nerves and Argyll-Robertson pupils, with knee jerks
present and station good. R. V. = 4/30, L. V. = 4/60.

Discussion. — Dr. Jackson believed the causative factor was
syphilis, and thought that the reduced caliber of the retinal
vessels suggested vascular disease.

Corneal Ulcer.

Dr. Stevens presented a man with a sluggish central ulcer
of the cornea and who had also suffered from a marked iritis.
V. = 2/60. Under atropia, hot applications and leeching the
ulcer was slowly healing.

Discussion, — Dr. Sisson suggested the intermittent X-ray
to promote nutrition.

liater Report of Removal of Steel From Vitreous.

Dr. Stevens also presented a case (reported at last meeting)
from which he had removed a piece of steel from the vitreous,
through a rent in lens, iris and cornea, by the use of a magnet.
The eye was quieting, but the tension was minus, and the
pupil was obliterated. The question of making an artificial
pupil would be considered later.

Discussion, — Dr. Black thought this case was doing well.
As posterior synechia had resulted he would consider freeing
these adhesions so as to make better connection between the
posterior and anterior chambers.



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aSO SOCIETY PROCEEDINGS.

• Secretary's Report for Five Years, April 29, 1905, to April

16, 1910.

During the five years that your present secretary has served
you, gratifying progress has been noted as to the quantity and
quality of the work of this society, increased efficiency on the
part of members, and a steady growth in its acknowledged
contributions to ophthalmic literature.

While noting the increase in membership from twenty to
twenty-six, it is pleasant to record that no loss has occurred
either from removal, resignation or death, in the past five
years. While some members have missed but one or two
meetings in this period, it has happened that the Secretary
alone has been privileged to attend every meeting. Of the
last six meetings, the member from Leadville has attended
all, traveling 3,000 miles for this purpose.

The tendency to read fewer papers and to make the meet-
ings almost wholly clinical, has seemed to meet with general
approval ; as has also the increasing number of cases presented
and reported.

It has been noticeable, not only that there have been more
of the new members who have discussed cases and papers,
but that all have entered more freely and frequently into the
discussions.

In the first two of the past five years, two journals pub-
lished reports of the proceedings of this society, while in the
last three years they have added circulation by appearing in
four.

Of books and journal articles published by individuals of
this society, and from the society's proceedings, the editors of
the Ophthalmic Year Book noted twenty-one contributions to
general ophthalmology in 1905 and sixty-three in 1909.

The influence of the society has been successfully exerted
to favor State legislation for the establishment of an institu-
tion for the industrial training of adult blind ; for the revision
of the school laws for the purpose of securing the recognition
and correction of physical defects in school children, and to
defeat a proposed optometry bill.

Two joint meetings have been held with rhinologists, to
discuss the relation of diseases of the eye with those of the
accessory sinuses, and a symposium on the ocular effects of
alimentary, renal and cardio-vascular disturbances was con-



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SOCIETY PROCEEDINGS. 683

ducted by ophthalmologists, neurologists and internists. The
society appropriately observed its tenth anniversary last year.
Two foreign professors of ophthalmology, J. Hirschberg
and C. Hess, and one holding an American chair, L. W. Fox,
have been honored guests of the society; and Professor
Hirschberg constitutes our only honorary member at the pres-
ent time.

Election of Officers.

Drs. G. F. Libby and Melville Black were re-elected as Sec-
retary and Treasurer, respectively, and Dr. E. R. Neeper was
chosen as Chairman of the Executive Committee for the ensu-
ing year.

George F. Libby,

Secretary.



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BOOK REVIEWS.

Diseases of the Eye.

IJy G. E. DE ScHwEiNiTZ, A. M., M. D., Professor of Ophthal-
mology in the University of Pennsylvania, Philadelphia.
W. B. Saunders Company, Philadelphia and London. Sixth
Edition, thoroughly revised. Price, cloth, $5.00.

The sixth edition of this well-known and tried text book on
ophthalmology reflects brilliantly the care and thoroughness
so characteristic of the author in his teaching and in all of his
literary work. The reader finds himself in touch with oph-
thalmology as practiced, we might say, up to the day of going
to press, and for reference he usually finds at once statements
that are positive, or positively negative. Little space is given
to the discussion of theories, but important theories are ex-
pressed in a brief and clear cut manner, easy to grasp and dif-
ficult to forget.

The present edition contains over nine hundred pages, three
hundred and fifty-one illustrations and seven chromo-litho-
graphic plates. Many subjects are introduced in special para-
graphs for the first time, among which are the use of the
crossed cylinder in refraction ; obstetric injuries of the cornea ;
posterior scleritis; cyanosis of the retina; atoxyl amblyopia;
the ocular complications of nasal accessory sinus disease ; inter-
mittent exophthalmos, and a number of operative procedures
which would seem to have established for themselves a definite
place in the ophthalmologist's store of resources.

We notice that the author is not yet ready to express his
personal opinion upon extraction of the lens in the capsule,
the operation as performed by Major Smith of India, and now
being tried and advocated by a small number of men in this
country. He very conservatively says: "If the operator de-
sires to perform extraction in the capsule (Major Henry
Smith's operation, also called the Indian operation) according
to Smith, he may proceed as follows.'* Then follows a brief
description of the operation from the Archives of Ophthal-
mology, and a few comments which are perfectly safe.



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BOOK REVIEWS. (>83

The reviewer sees wisdom and judgment in the manner in
which the author has handled this particular subject, which
has attracted so much attention in the last few years, and feels
that his conservatism might at least postpone the loss of many
eyes. Many- of us are doubtless anxious to try our hand at
this operation, but we still feel the need of authoritative back-
ing niearer home than India.

<While as a rule little criticism can be applied to the me-
chanical work of the publishers, we would suggest that new
plates for many of the illustrations would be appreciated in
the next edition.

William T. Shoemaker.

Refraction and How to Refract.

By James Thorington, A. M., M. D., Philadelphia. Fifth
Edition. Published, 1910, by P. Blakiston's Son and Com-
pany, Philadelphia. Price, $1.50.

It is less than one year since we had the pleasure of review-
ing the fourth edition of this popular work on refraction, and
while there have perhaps been few if any important advances
during this time in this particular field of ophthalmology, the
author has, by the addition of forty-two new illustrations, the
withdrawal of several which appeared in older editions, and
the Rearrangement of some of the text, improved his work and
better adapted it for the uses of the reader.

Through the five editions the author has been consistent in
keeping his book elementary and for the use of beginners in
the study of ophthalmology, and for practitioners of medicine
who have been imbued with the idea that they can be of most
use as general specialists. For beginners in ophthalmology,
and for those who will take a "look in'* on refraction irre-
spective of ophthalmology, the book is excellent. The author's
descriptions are for the most part brief, clear and practical,
and follow one another in a well arranged and systematic
manner.

As an example of the author's practical methods, we might
call attention to the illustrations on pages 76, 77 and 78, in
which are shown how the neighborhood may be bridled and
made to subserve the uses of the refractionist who wishes to
broaden his sphere beyond the narrow confines of his four
walls.



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«H4 BOOK REVIEWS.

Announcement is made that a translation of this work into
Chinese is, by request, now under preparation, a tribute which
must be very gratifying to Dr. Thorington, and for which he
is to be congratulated.

William T. Shoemaker.



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THF ANNALS

OF

OPHTiiALMOLOGY

Vol. XIX OCTOBER, 1910 No. 4



CONGENITAL PIGMENTATION OF THE CORNEA.*

T. B. HOLLOWAY, M. D.,

Philadelphia.

While all cases of congenital pigmentation of the cornea
are unusual, those cases conforming to the type first reported
by Krukenberg in 1899 may be regarded as rare. Since that
time several similar case histories have been reported in for-
eign journals, but to the best of my knowledge, the following
three histories are the first to be published from Afnerican
clinics :

Cask 1. — M. G., female, single aged 32; no occupation
aside from household duties. The patient first came to the eye
clinic of the University Hospital, November 14, 1906, com-
plaining of constant, dull, aching pain in each eye, aggravated
by near work. Her family history was negative, and her own
health had always been good, except for an attack of inter-
mittent fever eighteen years ago. Her eyes were first exam-
ined for glasses eight years ago, when she consulted an oculist
concerning the pain above referred to. There was no history
of any ocular trauma or other inflammatory processes, and
no muscae.

The pupils were equal and round, while the pupillary reac-
tions were prompt and normal ; the ocular rotations were full
in all directions.



♦Elaboration of the paper read before tbe American Ophthal-
mological Society, Washington, D. C, May, 1910.



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686 CONGENITAL PIGMENTATION OF CORNEA.

O. D. — With the ophthalmoscope one could note an exceed-
ingly faint, central, vertical linear opacity, and with a suitable
lens a faintly granular condition of the streak. When exam-
ined by oblique illumination and the naked eye, this streak
assumed a brownish tinge and was about 2^/2 mm. in length
and yi to I mm. in width. With a loupe it was seen to be
spindle-shaped, and made up of an accumulation of very fine,
quite uniform, golden-brown pigment dots, which were sit-
uated in the stroma of the cornea in the deeper layers, but
their exact depth could not be accurately determined. About
the periphery of the spindle the pigment dots were more iso-
lated than centrally, where they were more compact. The
overlying and adjacent portions of the cornea were perfectly
clear, and the anterior chamber was of normal depth and free
from any remnants of the pupillary membrane. The iris was
dark brown in color and normal in every way, while the lids,
lens, vitreous and fundus were likewise normal. Vision = 6/6.

O. S. — This was similar in every respect to its fellow, ex-
cept that the pigment line was slightly more pronounced, and
was just external to the center of the cornea. Vision = 6/12.

V. O. D. + .25 s. C + .50 c. axis 30 = 6/4—
V. O. S. — .25 s. C + 1.25 c. axis 180 = 6/5

I again examined this patient in July, 1909, and found the
ocular conditions unchanged.

Case 2. — B. C, female, single, aged 32 ; housemaid. Owing
to asthenopic symptoms, the patient first came to the Eye
Clinic of the University Hospital in 1907. Her family his-
tory and past medical history were negative. As a child she
was subject to styes, but there was no history of any ocular
trauma. The first refraction of the patient was ten years ago,
and she has been wearing glasses constantly since that time.
She has four brothers and two sisters, and but two of these
are wearing glasses.

,On the nasal side of each cornea a Pinguecula could be
noted, but there were no evidences of pigmentation of this
structure. The pupils were equal and the iris normal in char-
acter and responded freely to light; the ocular excursions
were normal.

O. D. — With the ophthalmoscope one could note a vertical,
centrally placed, spindle-shaped opacity, which presented a



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CONGENITAL PIGMENTATION OF CORNEA. .687

faintly granular appearance. With oblique illumination and
the loupe the streak was seen to be of a golden-brown color,
and the punctate condition was best noted about the periphery
of the pigmented area, as in Case 1. The opacity measured
3 mm. in length and 1 mm. in width, and was slightly more
pronounced than in the above case. The pigmentation was
observed to be in the deeper layers of the stroma of the cor-
nea, but here also it was difficult to determine its exact depth.
The other portions of the cornea were perfectly clear; the
anterior chamber was of normal depth, and no visible remains
of the pupillary membrane could be seen. The iris was blue-
gray in color, and, as above intimated, free from any synechiae.
The lids, lens, vitreous and fundus were normal.
Vision = 6/9.

O. S. — This presented conditions similar to those found in
the right eye. Vision = 6/7.5.

V. O. D. — 1.00 s. C — .50 c. axis 120 = 6/6
V. O. S. — 1.25 s. C — .25 c. axis 60 = 6/6

Since the above examination, this patient has been exam-
ined a number of times and as recently as one month ago, and
no change has been noted from the conditions as described.
(See colored plate.)

Case 3.-^P. L., female, single, aged 40. This patient first
consulted Dr. George E. de Schweinitz in February, 1901.
She stated that she had always been myopic and had worn
glasses for the past twenty-tive years. Her past medical his-
tory and family history were negative. She denied any pre-
vious ocular inflammations or trauma.

O. D. — Here, as in the two preceding cases, there was noted
in the stroma of the cornea a brownish, linear area, which
upon careful examination was seen to be finely granular. Its
position was just to the inner side of the center of the cornea
and vertical in direction. The remaining portions of the cor-
nea were perfectly normal. The pupillary reactions were
prompt, and no abnormalities were noted in the anterior cham-
ber, iris, lens, vitreous or fundus. Vision = 6/22.



Online Librarysciences et arts de la Dordogne Société d'agricultureThe Annals of ophthalmology → online text (page 65 of 82)