LITTLE: Case of Persistent Hyaloid Artery.
211
one day at a boys' school, when the several classes comning and going in the hall made such a disturbance that the principal stepped on. to the edge of the platform'i to stop it. He said notlhing, but merely looked at the lads. To ny surprise the noise ceased as soon as he had attracted attentioni. I thought to miyself, as I watched his face, well, that indefinite, aimiless expression anid gazing into distance won't qtuell such turbulence. Shortly after I called himii to look at the matches a color-blind boy had made with Holmgren's test, in which he saw, as he said, nothing out of the way or to comment on. It then flashe(d over miie that he was color-blind, which, upon examination, proved true. His peculiar look was this of the color-blind. I met him once afterward, coming hastily throughl a door in the postoffice, wlhen I caught his eyes first, and instantly noticed the expression as that of the color-blind, before I recognized the rest of hiis face. I have thus briefly called atte'ntioni to tlis singular peculiarity, which may prove of value in the detection of color-blinidness. I would attemiipt no explanation of it. Ocular expression is of course due to the muscles of the lids and face. As they, however, are' called into play from mental impressions derived through thle eye, it does not seem impossible that the color-blind eye miiay have its own peculiar facial expression.
A CASE OF PERSISTENT HYALOID ARTERY. (With Chromo-Lithograph.)
By WILLIAM S. LITTLE, M.D.,
PHILADELPHIA, PA.
WHIILE examining with the ophthalmloscope the right eve of a boy, six years of age, who had been sent to nme by Dr. Joseph Hearn, of Plhiladelphia, for the correqtion of a strabismtus convergens affecting the right eye, a persistent hyaloid artery was observed. The boy is smiiall and spare, has been treated successfully for hip disease by Dr. Hearn, and has had the same armii fractured twice. With the optlhalmoscope the optic nerve, without a physiological excavation and with slight pigmi-entation on its niasal side, is seen with a +4D. The appearance of the vessels on the face of the nervre is as follows: on the upper and outer quadrant are crowded, very circumflex,
212
LITTLE: Case of Persistent Hyaloid Artery.
and divide on the disc instead of on the retina as is usual; the artery macularis conies from the depth of the nerve, toward the periplhery, near the horizontal diamiieter of the disc. On the upper and iniier quadrant, the artery nasalis superior is circulmflex and divides on the disc; the vein nasalis superior passes directly to the centre of the disc. The ininer and lower quadrant has no niedialis vein or artery passing fromii the centre over it ; but branches from the nasalis inferior artery and veinls take their l)lace. rhe outer and lower quadranit, has the iimacularis vein upon it; between the two lower quadrants lies one large vein, representing the tenmporalis inferior and nasalis inferior veins ; there is no temnioralis inferior artery or nasalis inferior artery on the disc or on the retinia, but the vessel to be described takes their place, as will be shown in the description. The hyaloid artery observed arises abouit the centre of the disc; on the disc it passes downward, curving slightly towvard the nasal side, then curves outward to the edge ofthe disc; then takes a curve downward, forward, inward, curving gently upward, forward, outward; then sharply downward, forward, inward; sharply upward, forward, outward; sharply downwvard, forward, inward ; sharply tipward, forward, outward; then turns directly outward upon itself on a lhorizontal l)lane, and passes directly back -through the curves imiade by its progress. These curves numiber three; two anteriorly sLrrouniding the vessel as it passes backward the third is about three times as large as the others. When the vessel passes backward under the last curve (posterior one), best seen with a + 6D, it bifurcates, sending one branch curving downward toward and on the retina, this becomling the temporalis inferior artery; the second branch at the bifurcation of the artery goes toward the retina on the nasal side, below the horizontal plane, and before it reaches, divides into two branches, one representing the artery medialis on the retina, and the other the nasalis inferior artery. Dr. J. m. raylor, of Philadelphia, hias made a very accurate
H u ntErjI th P h
LITTLE: Case of Persistent Hyaloid Artery.
213
sketch of the fundus of the eye, showing the vessel in question and the general distribution of the vessels on the disc and retina ; it is a three-quarter outward appearance of the disc and vessel. He has also made a l)rofile picture (diagramlmatic) from the nasal side (see page 212). Its shape resemiibles a cork-screw. The calibre of the vessel corresponds to the other arteries in the nerve and retina. Its color is the samiie, except where it formis the loop on its extremiity, where it is much darker. To see it on the disc a + 4D is used; at its' bifurcation a +6D; the extremiie end is seen with a -tg-9D, and at times a + 12D, as it moves toward the extremiity; this shows the a-mount of oscillation. Fronm its color I believe blood to be passing, thirough it, and in its final distribution the vessels take the place of those that are genierally presept on the retina, arising fromii the optic nerve. The position of the vessel, and coming so far forward toward the l)osterior surface of the crystalline lens, enables it to be called a persistent hyaloid artery; thouigh I have thouglht at one timiie it miiight be a retinal vessel wandering through the hyaloid, the portion goinig to the crystalline lens havirg been absorbed. Heretofore I have seen only one case, of )ersistent hyaloid artery, and that was rudimiientary and( bloodless, and seen only close to the disc. Dr. Risley, of Philadelphia, has seen the patient, an(d I regret' that distance lhas prevented the attendance of the boy. The left eye presented no abnormality as to the vessels. I obtained witlh a +4D for the right eye ", it beinig ai-iblyopic. The left eye requiired a +33D to obtain "X. I divi(le( the tendon of the internal rectus of the right eye, correcting the strabismiius con vergens. As the boy (levelops, I desire to watch the condition of the vessel. T'he hypermetropia wvas no doubt the cause of the squinit.
211
one day at a boys' school, when the several classes comning and going in the hall made such a disturbance that the principal stepped on. to the edge of the platform'i to stop it. He said notlhing, but merely looked at the lads. To ny surprise the noise ceased as soon as he had attracted attentioni. I thought to miyself, as I watched his face, well, that indefinite, aimiless expression anid gazing into distance won't qtuell such turbulence. Shortly after I called himii to look at the matches a color-blind boy had made with Holmgren's test, in which he saw, as he said, nothing out of the way or to comment on. It then flashe(d over miie that he was color-blind, which, upon examination, proved true. His peculiar look was this of the color-blind. I met him once afterward, coming hastily throughl a door in the postoffice, wlhen I caught his eyes first, and instantly noticed the expression as that of the color-blind, before I recognized the rest of hiis face. I have thus briefly called atte'ntioni to tlis singular peculiarity, which may prove of value in the detection of color-blinidness. I would attemiipt no explanation of it. Ocular expression is of course due to the muscles of the lids and face. As they, however, are' called into play from mental impressions derived through thle eye, it does not seem impossible that the color-blind eye miiay have its own peculiar facial expression.
A CASE OF PERSISTENT HYALOID ARTERY. (With Chromo-Lithograph.)
By WILLIAM S. LITTLE, M.D.,
PHILADELPHIA, PA.
WHIILE examining with the ophthalmloscope the right eve of a boy, six years of age, who had been sent to nme by Dr. Joseph Hearn, of Plhiladelphia, for the correqtion of a strabismtus convergens affecting the right eye, a persistent hyaloid artery was observed. The boy is smiiall and spare, has been treated successfully for hip disease by Dr. Hearn, and has had the same armii fractured twice. With the optlhalmoscope the optic nerve, without a physiological excavation and with slight pigmi-entation on its niasal side, is seen with a +4D. The appearance of the vessels on the face of the nervre is as follows: on the upper and outer quadrant are crowded, very circumflex,
212
LITTLE: Case of Persistent Hyaloid Artery.
and divide on the disc instead of on the retina as is usual; the artery macularis conies from the depth of the nerve, toward the periplhery, near the horizontal diamiieter of the disc. On the upper and iniier quadrant, the artery nasalis superior is circulmflex and divides on the disc; the vein nasalis superior passes directly to the centre of the disc. The ininer and lower quadrant has no niedialis vein or artery passing fromii the centre over it ; but branches from the nasalis inferior artery and veinls take their l)lace. rhe outer and lower quadranit, has the iimacularis vein upon it; between the two lower quadrants lies one large vein, representing the tenmporalis inferior and nasalis inferior veins ; there is no temnioralis inferior artery or nasalis inferior artery on the disc or on the retinia, but the vessel to be described takes their place, as will be shown in the description. The hyaloid artery observed arises abouit the centre of the disc; on the disc it passes downward, curving slightly towvard the nasal side, then curves outward to the edge ofthe disc; then takes a curve downward, forward, inward, curving gently upward, forward, outward; then sharply downward, forward, inward; sharply upward, forward, outward; sharply downwvard, forward, inward ; sharply tipward, forward, outward; then turns directly outward upon itself on a lhorizontal l)lane, and passes directly back -through the curves imiade by its progress. These curves numiber three; two anteriorly sLrrouniding the vessel as it passes backward the third is about three times as large as the others. When the vessel passes backward under the last curve (posterior one), best seen with a + 6D, it bifurcates, sending one branch curving downward toward and on the retina, this becomling the temporalis inferior artery; the second branch at the bifurcation of the artery goes toward the retina on the nasal side, below the horizontal plane, and before it reaches, divides into two branches, one representing the artery medialis on the retina, and the other the nasalis inferior artery. Dr. J. m. raylor, of Philadelphia, hias made a very accurate
H u ntErjI th P h
LITTLE: Case of Persistent Hyaloid Artery.
213
sketch of the fundus of the eye, showing the vessel in question and the general distribution of the vessels on the disc and retina ; it is a three-quarter outward appearance of the disc and vessel. He has also made a l)rofile picture (diagramlmatic) from the nasal side (see page 212). Its shape resemiibles a cork-screw. The calibre of the vessel corresponds to the other arteries in the nerve and retina. Its color is the samiie, except where it formis the loop on its extremiity, where it is much darker. To see it on the disc a + 4D is used; at its' bifurcation a +6D; the extremiie end is seen with a -tg-9D, and at times a + 12D, as it moves toward the extremiity; this shows the a-mount of oscillation. Fronm its color I believe blood to be passing, thirough it, and in its final distribution the vessels take the place of those that are genierally presept on the retina, arising fromii the optic nerve. The position of the vessel, and coming so far forward toward the l)osterior surface of the crystalline lens, enables it to be called a persistent hyaloid artery; thouigh I have thouglht at one timiie it miiight be a retinal vessel wandering through the hyaloid, the portion goinig to the crystalline lens havirg been absorbed. Heretofore I have seen only one case, of )ersistent hyaloid artery, and that was rudimiientary and( bloodless, and seen only close to the disc. Dr. Risley, of Philadelphia, has seen the patient, an(d I regret' that distance lhas prevented the attendance of the boy. The left eye presented no abnormality as to the vessels. I obtained witlh a +4D for the right eye ", it beinig ai-iblyopic. The left eye requiired a +33D to obtain "X. I divi(le( the tendon of the internal rectus of the right eye, correcting the strabismiius con vergens. As the boy (levelops, I desire to watch the condition of the vessel. T'he hypermetropia wvas no doubt the cause of the squinit.
