A
CASE
OF
TUMOUR
IN
THE
ORBIT.
By F. Richardson Cross, M.B. Lond., F.R.C.S.; Surgeon to the Bristol Eye Hospital, Ophthalmic Surgeon to the Bristol Royal Infirmary.
following case is unusual in its clinical history. I am of opinion that it is not any form of gumma, nor a hydatid; it can scarcely be looked upon as inflammatory, though its histology is probably similar to granulation tissue-formations. There can be no longer any suspicion of its malignant nature. The
G., aged 35, in 1884 was "out of sorts," and able to take very little exercise. He considers that his illness commenced with a chill taken during his work Thomas
was
in
a
newly-built
weeks,
His health varied for
a
few
suddenly became very much worse. He frequently from severe chills, amounting to rigors.
when he
suffered He lost to
washhouse.
flesh; struggle on
very languid and tired ; but managed with his work as a shoemaker. He somewas
times noticed a weakness of his liable to styes.
right
eye, which seemed
TUMOUR
igO
Dropsy ing
soon
ORBIT.
then showed itself in the
into the
able to
THE
IN
For
and face.
body
a
legs, gradually
week he
up with pillows; but he his business.
breathe, propped
after to
resume
At this time he noticed toothache and in the
was
pass-
scarcely was
able
neuralgic pains
side of his
face, a peculiar numbness of the cheek at meal times, and stiffness of the upper jaw,, right He had also a as though it did not belong to him. contracted of the lower lid, feeling peculiar pinched-up,
right
There
nose, and cheek.
upon the
After the
dropsy subsided,
both lids remained swollen.
was next
seized with
trunk of the He
evidently pressure superior maxillary nerve; right. was
a
most acute
pain
on
the
side of the apex of the head, specially marked at spot, where it seemed to perforate the skull; it
accompanied by head,
of the
neuralgia
which resisted all treatment
Double vision eye
severe
began
was
then
noticed,
nose
right one was
and fore-
(ophthalmic nerve). right
till the lid of the
and covered the
sight (motor oculi). discovered, on was the that lid, quite blind; and right eye the Bradford Eye Institution. Here it was
to
drop
About six weeks from this time he
raising
the
he went to
observed
swelling
that there on
each
was
a
considerable
submaxillary prominence Galvanism produced no
side, especially right.
of the
No
eyeball was noticed. the ptosis. There was absence of sensation on the forehead, upper part of the head and cheek, on the right side. His head felt very heavy on the pillow, and there were severe pains on both sides of the neck, as well as acute pain in the face and head. The ear was not affected, nor the lower jaw, except mechanically by effect
the not
on
submaxillary swellings. enjoy his food.
He had taste, but he could
TUMOUR IN
A
after
fortnight
noticed to
protrude.
THE
ORBIT.
igr the
reaching Bradford,
and when he left he could not close the lids He says the tumour
globe.
was
was
eye
He remained there two
months, over
considered to be
the
malig-
nant at the base of the
After
a
skull, pushing forward the eye. short time he came under the care of one of
the surgeons in the Leeds Infirmary. At the commencement of 1885 the eye was continuing to protrude, and was now itself the main seat of the pain. There was a red
the lower lid
(conjunctival chemosis), swelling under each jaw. The surgeons had differences of opinion as to the character of the disease, and no special treatment was adopted for He was then most energetically treated about a month. and inunctions; by it his teeth medicines mercurial by large
mass over
and there
were
was
loosened and his mouth ulcerated:
nothing
Hospital
returned
became
he could take
solid for five weeks.
the Leeds soon
tremendous
He says, whilst he was in he became totally blind, but the sight
to the left eye.
The
proptosis
of the
right
marked, and the eye seemed to lie out upon Three months after his admission, removal of
more
the cheek.
the eye was recommended, and would have been done, but that his surgeon fell ill and the patient went home for
change. He says that nothing gave way, swelling gradually subsided without discharge,
a
he returned
to the
hospital they scarcely
had been living mainly sion at
wire,
Leeds,
on suet
the lids
were
and milk. sewn
but that the so
that when
knew him.
He
After re-admis-
together
with silver
protect the cornea, which was becoming He admits that at this time there was so much
in order to
cloudy. discharge
that it
required syringing out,
and attributed it
to inflammation of the eye resulting from the stitches. He seems certain there was no discharge from the eye
TUMOUR IN
I92
THE ORBIT.
(Had the discharge commenced in the fortnight home, the subsidence of the swelling would be explained by suppuration of part of the neoplastic tissue.) before. he
was at
The stitches
removed from the lid at the end of
were
three weeks, and the an
out-patient
cornea
had
at Leeds for two
improved. He months, taking
remained iodide of
potassium. In the middle of
Infirmary,
under my care in the He very thin and pale. of syphilis, and said that mercury he
1885 He
Bristol.
came
was
denied any history always did him harm, but that he felt better when
taking
potassium. All his organs were healthy; there The left eye was quite healthy; the anasarca.
iodide of was no
right was prominent, but could be completely covered by the lids, which, however, opened very imperfectly. The elevator
paralysed.
was not
There
was a
distinct hard
non-pulsatile nodule, as large as a nut, along the lower orbit, which pushed up the eye and was lost in swelling of the conjunctiva, which was very injected
floor of the
and swollen
over
it.
The eye
was
only capable
of the
movement in any direction ; the cornea showed
slightest leucomata,
but
was not
inflamed.
There
was a
slight
but
definite fulness below the malar bone and zygoma, and above the zygoma in the temple; but the movements of the
jaw
There
evidently a growth spheno-maxillary fissure, causing oedema merely of the temporal and pterygoid regions (for there was no impairment here of nerve or muscular function), surrounding the optic nerve and muscles of the eye, and passing forwards along the anterior extremity of the fissure to the lower wall of the orbit; but the pathology of the growth were not
impaired.
was
in the
was
uncertain.
I still have the
case
under observation.
The
swelling
TUMOUR IN
has
gradually subsided,
size.
remains,
and there is
no
sure
it is not
193
growth
implicated
nerves
movement of the eye.
time there has been
observed of the
ORBIT.
but at uncertain times it varies in
Partial anaesthesia of the
some
feel
THE
no
under
syphilitic,
still For
pain. From what I have anti-syphilitic remedies, I
and the
man
has
never
shown
I have never trusted any other symptom of this disease. to an the make incision tumour, which is myself along still
as
large
as a nut at
the lower wall of the
I sometimes feel uncertain if it is be
glad
of
an
excuse
is
for
perfectly blind with difficulty through hazy
orbit;
but
and I should
hydatid, exploratory incision. The eye atrophy of the disc, seen with a
an
media.
I may add that on October 21st, 1886, Messrs. Critchett and Juler exhibited a case at the Ophthalmothis one in many respects. I mentioned my case at that meeting, but it has not before been published as I was anxious to keep it longer
logical Society, resembling
under observation.