LAMBERT: Exhibition of Pkotographs- of Cese.
402
EXHIBITION OF PHOTOGRAPHS OF CASES.: BY WALTER EYRE LAMBIRT, M.D., 'NEW YORK, N. Y.
CASE I. CONGENITAL COLOBOMA OF LID.
On July I3io90i, a very poorly-nourished, delicate-looking child, female, aged seven, was brought to see'me at the New York Eye & Ear Infirmary on account of a defect in the upper lid of left'eye, which had existed since birth. An examination showed it to be a case-of congenital coloboma of the. upper lid, with a symblepharon extending from the margin of the cornea upwards and inwards, corresponding to the defect in the lid, and attached at its base to the cutaneous surface of the lid at what would have been'the inner canthus (see Fig. I). The child also had other evidences of congenital malformation, namely, web fingers on both hands, and. web toes on both. feet. The operation was made under ether, the symblepharon dissected out, orbital conjunctiva undermined and brought together with fine sutures, the edges of coloboma denuded and brought together with sutures, external canthoplasty made to relieve tension of sutures, and bandage applied. All except the lower portion Qf the wound healed- by first intention, very much improving the condition, leavin'g, however, a small triangular coloboma. The patient was re-admitted. in two weeks and a second similar operation was made, the edges of the coloboma'being' denud,Tde and sutured. The result was most satisfactory. DISCUSSION.
DR. GRUENING. -I have had a similar case of congenital coloboma on the lid and operated in the same way except that I had better success by using what is called' an intramarginal suture.
fB
LAMBERT. - Coloboma lid.
I*I.
$
LAMBERT. Exhibition of Photographs of Cases.
-.40.3
DR KoLLER:- I have operated also on a case and in-order to avoid this difficulty I have used such a suture as is used in treating hare-lip cases.
CASE II. HYPERTROPHY OF LACHRYMAL GLAND.
During my service at the New York Eye & Ear Infirmary last summer a young woman, aged nineteen, presented herself for treatment on account of a very extensive swelling on both upper lids, which she first noticed six years ago and which has been gradually increasing since. Fig. i gives a very good idea of the appearance of the patient. On examining the lids it was found that a very extensive tumor existed, which increased very much in size when the patient leaned forward, depressing the head. The tumor gave the impression on palpation of being an angioma, and was supposed to be such. Operation was advised and consented to by the patient. The right eye, in which the tumor seemed to be larger than the left, was first operated upon, a horizontal incision being made in the upper lid and the tumor carefully dissected out, which was very soon discovered during the operation to be, not an angioma but a glandular tumor, extending very deeply back into the orbit. The wound in the lid was sutured and bandage applied, and in a.few days the patient was discharged cured. A certain amount of ptosis followed the operation and remained for about two weeks, but subsequently entirely disappeared. The left eye was operated upon a few weeks afterwards, with similar satisfactory result. Fig. 2 is a picture tak-en about one month after the operation, and shows the very satisfactory result of the operation. The specimens were referred to Dr. George S;, Dixon, Assistant Pathologist of the New York Eye & Ear Infirmary, who submitted the following report: "In the matter of Miss Mary McQ., nineteen years, No. 20,049, operated on by you in September, Igoo, I beg leave to
402
EXHIBITION OF PHOTOGRAPHS OF CASES.: BY WALTER EYRE LAMBIRT, M.D., 'NEW YORK, N. Y.
CASE I. CONGENITAL COLOBOMA OF LID.
On July I3io90i, a very poorly-nourished, delicate-looking child, female, aged seven, was brought to see'me at the New York Eye & Ear Infirmary on account of a defect in the upper lid of left'eye, which had existed since birth. An examination showed it to be a case-of congenital coloboma of the. upper lid, with a symblepharon extending from the margin of the cornea upwards and inwards, corresponding to the defect in the lid, and attached at its base to the cutaneous surface of the lid at what would have been'the inner canthus (see Fig. I). The child also had other evidences of congenital malformation, namely, web fingers on both hands, and. web toes on both. feet. The operation was made under ether, the symblepharon dissected out, orbital conjunctiva undermined and brought together with fine sutures, the edges of coloboma denuded and brought together with sutures, external canthoplasty made to relieve tension of sutures, and bandage applied. All except the lower portion Qf the wound healed- by first intention, very much improving the condition, leavin'g, however, a small triangular coloboma. The patient was re-admitted. in two weeks and a second similar operation was made, the edges of the coloboma'being' denud,Tde and sutured. The result was most satisfactory. DISCUSSION.
DR. GRUENING. -I have had a similar case of congenital coloboma on the lid and operated in the same way except that I had better success by using what is called' an intramarginal suture.
fB
LAMBERT. - Coloboma lid.
I*I.
$
LAMBERT. Exhibition of Photographs of Cases.
-.40.3
DR KoLLER:- I have operated also on a case and in-order to avoid this difficulty I have used such a suture as is used in treating hare-lip cases.
CASE II. HYPERTROPHY OF LACHRYMAL GLAND.
During my service at the New York Eye & Ear Infirmary last summer a young woman, aged nineteen, presented herself for treatment on account of a very extensive swelling on both upper lids, which she first noticed six years ago and which has been gradually increasing since. Fig. i gives a very good idea of the appearance of the patient. On examining the lids it was found that a very extensive tumor existed, which increased very much in size when the patient leaned forward, depressing the head. The tumor gave the impression on palpation of being an angioma, and was supposed to be such. Operation was advised and consented to by the patient. The right eye, in which the tumor seemed to be larger than the left, was first operated upon, a horizontal incision being made in the upper lid and the tumor carefully dissected out, which was very soon discovered during the operation to be, not an angioma but a glandular tumor, extending very deeply back into the orbit. The wound in the lid was sutured and bandage applied, and in a.few days the patient was discharged cured. A certain amount of ptosis followed the operation and remained for about two weeks, but subsequently entirely disappeared. The left eye was operated upon a few weeks afterwards, with similar satisfactory result. Fig. 2 is a picture tak-en about one month after the operation, and shows the very satisfactory result of the operation. The specimens were referred to Dr. George S;, Dixon, Assistant Pathologist of the New York Eye & Ear Infirmary, who submitted the following report: "In the matter of Miss Mary McQ., nineteen years, No. 20,049, operated on by you in September, Igoo, I beg leave to
