LITTLE: Two Cases of Ectopia Lentis.
521
ciple would be by means of-some form of aspirator so as to draw the fluid from between the retina and the choroid. DR. WEBSTER had had experience in one case of the use of hypodermic injection of pilocarpin in the Manhattan Eye and Ear Hospital. Some fifteen or twenty injections were given without any benefit. The case occurred in an out-patient. About the time the injections were ceased abscesses began to develop, and at every point where a puncture. had been m'ade an abscess formed. Possibly if the patient had been kept in bed, the result would have been better. He had reported to the Society two cases in which the retina was re-attached by simply keeping the patient in bed two or three weeks. He also thought Dr. Prout had reported a case treated in the same way. DR. THEOBALD asked Dr. Mittendorf if he believed any advantage accrued from giving pilocarpine hypodermically. He had employed it in some cases, but had not thought it necessary to give it hypodermically, as he obtained the full constitutional effects of the drug by administering it by the mouth.
TWO CASES OF ECTOPIA LENTIS, CONGENITAL DOUBLE; ONE CASE NON-SYMMETRICAL, THE OTHER SYMMETRICAL. (With wcodcuts.)
BY W. S. LITTLE, M. D., PHILADELPHIA, PA.
, aged twenty-three, was seen January 2, i88o. MR. Is very tall and spare; has a malformed chest-wall and ncevus
Non-Symmetrical.
on right hand. Right eye divergent strabismus. T-remulous iris in each eye; states a cousin is similarly affected; father is color-blind. Has experienced no trouble with his eyes, be-
522
LITTLE: Two Cases of Ectopia Zentis.
yond the discomfort of restricted vision and annoyance of holding objects very close and uses only the left eye. Has been living in the country but desires to gain a position in the city. R. E., V. _ . L. E.,2 V. LEX-X R. E. (mydriatic): Pupil dilated very slightly. Crystalline lens is displaced upward and inward at about 450; the lower margin of lens appears about the lower third of pupil; some vitreous opacities exist, but lens is clear as far as can be observed. Field of vision good. Tension of eyeball slightly reduced: + 8 +I2 cyl.ax. I8o0; V. L-LX-; + 3 _+ I2 cyl. ax. i8o0; Snellen VI. at I2". L. E.: lens in same position as R. E. at the sclero-corneal margin up and out at 450; there is a slight prominence, more so than in R. E., corresponding to the position of the lens. Lens clear, also vitreous. Tension -; + 8 + i8 cyl. ax. -=L' ; + 32 + I8 cyl. ax. I800; Snellen I. at 12". 180° Glasses were ordered as above. November 2, i880.-Had worn glasses with comfort and was in a position earning his living. R. E., + 7 2+ I2 cyl. ax. i8o0 ; V. =j. L. E., + 72 + i8 cyl. ax. I800; V. = XlX'X; + 4 with cylinders were given for writing. Seen February I7, I882.-R. E., V. = j5X L. E., V.(with glasses). Has no trouble. April 5, I883.-Consulted me, stating that his vision in the L. E. was bad, and had become so suddenly. A few evenings before I saw him, as he was walking, he thought some one had struck at him and he dodged the blow, when on looking around he could observe no one near him to have done so; vision has been bad since. Externally the L. E. on the outer scleral side shows rupture of an episcleral vessel. The tension of eye is reduced beyond the R. E. Objects the first few days appeared red; are now yellowish. Field is limited to objects on left side; central vision is lost. Ophthalmoscope shows a detachment of retina, slight in extent, up and out, dependent, and inter-
LITTLE: Two Cases of Ectopia. Lentis.
523
fering with central sight. He was leeched; given potassa iodid. April i6th.-Vision had improved. I gave muriate ammonia internally. June 22d.-Sees objects down and in and out sufficiently for protection; central vision defective; no total loss of field. V. = LX; sees better in sunlight. If I am correct, observes the fluctuation of the slight detachment as it is reflected from his lens. R. E.,+ 7, V. -X; +4, Jaeger No. i at 8". The left eye is now diverging, the right eye doing the work. Vision had improved a little in the L. E. when last heard from. The non-symmetrical position of the lenses in this case, is of interest; and the question arises, as to what influence the glasses may have had in producing the condition in the left eye. The immunity for three years and freedom from trouble, favors strongly their not being a factor. He had become able to see so well and became so interested in his pursuits that he had come to accept responsibilities, sufficiently difficult for a well-formed eye. He bleeds very easily when scratched. Whether a ncevoid condition existed in the left eye, as elsewhere on his person, is, of course, impossible to consider. The sketch of the case by Dr. J. M. Taylor is accurate. (See woodcut on page 522.)
Symmetrical.
In addition to this case I desire to present another case, one of symmetrical ectopia lentis as occurring in the practice of C. S. Turnbull, M.D., iof Philadelphia, and treated in thesame way as my own. Dr. J. M. Taylor has sketched it very accurately. (See woodcut above.) The patient was a male,
34
524
STEVENS: Employment of Nitrous Oxide as
aged sixteen, tall and spare. V. =-I (binocular). Jaeger No. 4 at j", R. E.; No. 4 at 2", L. E. Seen October 3, I880.-Pupils dilated about one-half, under atropia; lenses misplaced down and inward in each eye. Lenses slightly opaque. R. E., + 4, V. = , + 21. Jaeger No. i at 8". L. E., 4. 3, V. = L, + 2i. Jaeger No. i at 8". Patient had a contracted, highly vaulted roof of mouth; also mitral insufficiency. He wore his glasses with great comfort for over a year; was accidentally killed. REMARKS. DR. MITTENDORF referred to a case occurring in a girl, twenty-three years of age, otherwise perfectly healthy, who complained of her eyes, and on examination he found that the lenses were dilslocated inward and upward. He gave the patient plus two and a half for near and four for distant vision, and she got on very well. He suspected that in this instance the difficulty was due to arrest of development in the suspensory ligament, and besides the lens was also smaller than normal and of different refractive power.
ON THE EMPLOYMENT OF NITROUS OXIDE AS AN ANAESTHETIC IN OPHTHALMIC OPERATIONS. BY GEO. T. STEVENS, M.D., NEW YORK.
WHILE the use of- nitrous oxide gas as an anasthetic is no novelty, its employment has been so largely confined to operations upon the teeth that its merits in other classes of surgical operations have been to some extent overlooked. Its more general use in ophthalmic surgery would doubtless be greatly to the advantage of patients and surgeons. Laughing-gas, in certain classes of operations, possesses several advantages over all other anesthetics. It is the least dangerous, its use is not attended with nausea, headache, and other unpleasant symptoms characteristic of the use of ether or chloroform, and It demands for its administration
521
ciple would be by means of-some form of aspirator so as to draw the fluid from between the retina and the choroid. DR. WEBSTER had had experience in one case of the use of hypodermic injection of pilocarpin in the Manhattan Eye and Ear Hospital. Some fifteen or twenty injections were given without any benefit. The case occurred in an out-patient. About the time the injections were ceased abscesses began to develop, and at every point where a puncture. had been m'ade an abscess formed. Possibly if the patient had been kept in bed, the result would have been better. He had reported to the Society two cases in which the retina was re-attached by simply keeping the patient in bed two or three weeks. He also thought Dr. Prout had reported a case treated in the same way. DR. THEOBALD asked Dr. Mittendorf if he believed any advantage accrued from giving pilocarpine hypodermically. He had employed it in some cases, but had not thought it necessary to give it hypodermically, as he obtained the full constitutional effects of the drug by administering it by the mouth.
TWO CASES OF ECTOPIA LENTIS, CONGENITAL DOUBLE; ONE CASE NON-SYMMETRICAL, THE OTHER SYMMETRICAL. (With wcodcuts.)
BY W. S. LITTLE, M. D., PHILADELPHIA, PA.
, aged twenty-three, was seen January 2, i88o. MR. Is very tall and spare; has a malformed chest-wall and ncevus
Non-Symmetrical.
on right hand. Right eye divergent strabismus. T-remulous iris in each eye; states a cousin is similarly affected; father is color-blind. Has experienced no trouble with his eyes, be-
522
LITTLE: Two Cases of Ectopia Zentis.
yond the discomfort of restricted vision and annoyance of holding objects very close and uses only the left eye. Has been living in the country but desires to gain a position in the city. R. E., V. _ . L. E.,2 V. LEX-X R. E. (mydriatic): Pupil dilated very slightly. Crystalline lens is displaced upward and inward at about 450; the lower margin of lens appears about the lower third of pupil; some vitreous opacities exist, but lens is clear as far as can be observed. Field of vision good. Tension of eyeball slightly reduced: + 8 +I2 cyl.ax. I8o0; V. L-LX-; + 3 _+ I2 cyl. ax. i8o0; Snellen VI. at I2". L. E.: lens in same position as R. E. at the sclero-corneal margin up and out at 450; there is a slight prominence, more so than in R. E., corresponding to the position of the lens. Lens clear, also vitreous. Tension -; + 8 + i8 cyl. ax. -=L' ; + 32 + I8 cyl. ax. I800; Snellen I. at 12". 180° Glasses were ordered as above. November 2, i880.-Had worn glasses with comfort and was in a position earning his living. R. E., + 7 2+ I2 cyl. ax. i8o0 ; V. =j. L. E., + 72 + i8 cyl. ax. I800; V. = XlX'X; + 4 with cylinders were given for writing. Seen February I7, I882.-R. E., V. = j5X L. E., V.(with glasses). Has no trouble. April 5, I883.-Consulted me, stating that his vision in the L. E. was bad, and had become so suddenly. A few evenings before I saw him, as he was walking, he thought some one had struck at him and he dodged the blow, when on looking around he could observe no one near him to have done so; vision has been bad since. Externally the L. E. on the outer scleral side shows rupture of an episcleral vessel. The tension of eye is reduced beyond the R. E. Objects the first few days appeared red; are now yellowish. Field is limited to objects on left side; central vision is lost. Ophthalmoscope shows a detachment of retina, slight in extent, up and out, dependent, and inter-
LITTLE: Two Cases of Ectopia. Lentis.
523
fering with central sight. He was leeched; given potassa iodid. April i6th.-Vision had improved. I gave muriate ammonia internally. June 22d.-Sees objects down and in and out sufficiently for protection; central vision defective; no total loss of field. V. = LX; sees better in sunlight. If I am correct, observes the fluctuation of the slight detachment as it is reflected from his lens. R. E.,+ 7, V. -X; +4, Jaeger No. i at 8". The left eye is now diverging, the right eye doing the work. Vision had improved a little in the L. E. when last heard from. The non-symmetrical position of the lenses in this case, is of interest; and the question arises, as to what influence the glasses may have had in producing the condition in the left eye. The immunity for three years and freedom from trouble, favors strongly their not being a factor. He had become able to see so well and became so interested in his pursuits that he had come to accept responsibilities, sufficiently difficult for a well-formed eye. He bleeds very easily when scratched. Whether a ncevoid condition existed in the left eye, as elsewhere on his person, is, of course, impossible to consider. The sketch of the case by Dr. J. M. Taylor is accurate. (See woodcut on page 522.)
Symmetrical.
In addition to this case I desire to present another case, one of symmetrical ectopia lentis as occurring in the practice of C. S. Turnbull, M.D., iof Philadelphia, and treated in thesame way as my own. Dr. J. M. Taylor has sketched it very accurately. (See woodcut above.) The patient was a male,
34
524
STEVENS: Employment of Nitrous Oxide as
aged sixteen, tall and spare. V. =-I (binocular). Jaeger No. 4 at j", R. E.; No. 4 at 2", L. E. Seen October 3, I880.-Pupils dilated about one-half, under atropia; lenses misplaced down and inward in each eye. Lenses slightly opaque. R. E., + 4, V. = , + 21. Jaeger No. i at 8". L. E., 4. 3, V. = L, + 2i. Jaeger No. i at 8". Patient had a contracted, highly vaulted roof of mouth; also mitral insufficiency. He wore his glasses with great comfort for over a year; was accidentally killed. REMARKS. DR. MITTENDORF referred to a case occurring in a girl, twenty-three years of age, otherwise perfectly healthy, who complained of her eyes, and on examination he found that the lenses were dilslocated inward and upward. He gave the patient plus two and a half for near and four for distant vision, and she got on very well. He suspected that in this instance the difficulty was due to arrest of development in the suspensory ligament, and besides the lens was also smaller than normal and of different refractive power.
ON THE EMPLOYMENT OF NITROUS OXIDE AS AN ANAESTHETIC IN OPHTHALMIC OPERATIONS. BY GEO. T. STEVENS, M.D., NEW YORK.
WHILE the use of- nitrous oxide gas as an anasthetic is no novelty, its employment has been so largely confined to operations upon the teeth that its merits in other classes of surgical operations have been to some extent overlooked. Its more general use in ophthalmic surgery would doubtless be greatly to the advantage of patients and surgeons. Laughing-gas, in certain classes of operations, possesses several advantages over all other anesthetics. It is the least dangerous, its use is not attended with nausea, headache, and other unpleasant symptoms characteristic of the use of ether or chloroform, and It demands for its administration
