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.

A Case of Tumour in the Orbit.

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