WILSON: Sympathetic In/ammation.
49
TWO CASES OF SYMPATHETIC INFLAMMATION. BY DR. F. M. WILSON, BRIDGEPORT, CONN.
Cases of sympathetic plastic irido-choroiditis, with their inflexible rule of blindness, are dreary reading at the best, and I have sometimes wondered how many such cases it takes to convince the average man that there are no exceptions to this rule. When I sent my title to the committee I had under my care two cases of sympathetic irido-choroiditis of this plastic variety, in which useful vision had persisted for about a year, since that time " the rule " has claimed one of them; his vision has gone down to 3/200, and will probably continue to "go." The other is as follows: CHARLES HAMMILL, age 7, October IO, I891. - Hit in right eye with a piece of wood, size unknown, about two hours ago; rupture of globe, 4 to 5 mm. long in ciliary region below; some vitreous lost; vitreous hanging from wound; anterior chamber filled with blood; good P. L. December 8, *89i (two months later). Right eye quiet; total posterior synechia; lens opaque; eyeball soft; defective P. L.; enucleation advised, but declined. I did not see him again until 'anuary, I893 (two years later), when I treated him for suppurative otitis, and again advised enucleation of right eye, V without success. May IS, I893. He comes with irido-choroiditis established in left eye; slight redness; slight photophobia; yellowish exudation on surface of iris and into pupillary space; four-fifths of pupillary edge of iris adherent; vitreous cloudy; R. V. = Preventive enucleation was, of doubtful P. L.; L. V. = t course, no longer possible, nevertheless, as there was no possibility of sight in the right eye, it was enucleated on May I7, i893. rune I, I893. Vision has gone down to 4/200, chiefly by reason of increased opacity of vitreous. OPH.-4
so
WILSON: Sympathetic Inflammation.
On September 8, I893, eye quiet; redness and photophobia gone; L. V.=a2% Feb. 14, 1894. May I I, I894. Mlay i8, 1894. L. V.=L. V.=+ + L. V.= AThe iris has been kept continuously under the influence of atropine, which has been practically the only treatment. He took hydriodic acid for several weeks, but has had none for nine months or more. In place of the excluded case I have taken the liberty to report another, where the question might be raised as to whether enucleation did not cause inflammation in the other eye. MRS. ARTHUR W., age 30, December 6, 1893. -In October, I882, eleven years ago, she first came to me with large central perforation of left cornea, the result of purulent conjunctivitis. At that time a large leucoma formed with complete anterior synechia, and slow disorganization of left eyeball since 1882. This disorganized globe has become red and painful quite a number of times, and that is what she now comes for. December 12, I893. Under leeches, atropine, and hot water, the left eyeball is getting quiet; no symptoms in right; R. V. 2 ° and No. I at 6 in. I next saw her on February io, i894. She has now anotIir attack of pain and redness in left eyeball, and for the first time is willing to consider the question of enucleation. Again under leeches, atropine, and hot water, the eye got quiet, and on February 28, 1894, I enucleated it at the Bridgeport Hospital. The tissues about the ball were more or legs matted together, but the enucleation was easy, and nothing unusual occurred. One maneuver, perhaps, should be mentioned. For a year or more at all my enucleations, just before the dressings were applied, I have flooded the tissues with absolute alcohol - i. e., taking a piece of cotton or gauze saturated with alcohol, with a gentle boring motion I have thrust it to the very bottom of the cavity from which the eyeball came. It has always seemed to me that the healing took place much more kindly. March I, I894. First dressing; wound healing kindly. March 2, 1894, Wound healthy.
WILSON: Sympathetic Inflammation.
5t
March 3, I894 (three days after operation), she was discharged from hospital. Up to the day of operation her right eye was tested, either by my associate, Dr. Miles, or myself, every day, and we always found v3vision and good accommodation, with absence of pain, redness, photophobia, or epiphora. During the four days she was in the hospital her vision and accommodation were not tested, but she did not have pain, redness, photophobia, or epiphora. March 7, I894. During last night pain suddenly attacked right eye. It was severe enough so that her husband gave her two A-grain morphine pills before morning. She now comes to office with pain, redness, photophobia, and epiphora. Her vision is 2; she reads No. i Jaeger at six inches. There is no pink zone over ciliary region; the engorgement is principally of the large blood vessels. There is distinctly more redness over the external rectus than in other parts of ball. This area is also tender to touch, while other parts of eyeball are not. The iris reacts promptly to light; there are no posterior synechiae. In an eye unexposed to sympathetic inflammation, I should have made a diagnosis of episcleritis. March 14, 1894. Symptoms have slowly subsided. The pain has seemed out of proportion to the other symptoms. Hot water fomentations locally and antipyrin in 5-grain doses internally have given her more relief than anything else. March I5, I894. Relapse; eye very red and painful again; kept her awake all last night; slight chemosis; hot water and antipyrin resumed. March 26, I894. All pain has gone; slight redness persists. April 5, i 894. Eye quiet;, vision normal. There are three ways of explaining this case: Ist. That the pain, redness, etc., had nothing to do with the other eye. 2d. That sympathetic irritation started before the enucleation, but was in some mysterious way delayed on the route. 3d. That the enucleation caused the sympathetic irritation. The last seems to me most probable.
49
TWO CASES OF SYMPATHETIC INFLAMMATION. BY DR. F. M. WILSON, BRIDGEPORT, CONN.
Cases of sympathetic plastic irido-choroiditis, with their inflexible rule of blindness, are dreary reading at the best, and I have sometimes wondered how many such cases it takes to convince the average man that there are no exceptions to this rule. When I sent my title to the committee I had under my care two cases of sympathetic irido-choroiditis of this plastic variety, in which useful vision had persisted for about a year, since that time " the rule " has claimed one of them; his vision has gone down to 3/200, and will probably continue to "go." The other is as follows: CHARLES HAMMILL, age 7, October IO, I891. - Hit in right eye with a piece of wood, size unknown, about two hours ago; rupture of globe, 4 to 5 mm. long in ciliary region below; some vitreous lost; vitreous hanging from wound; anterior chamber filled with blood; good P. L. December 8, *89i (two months later). Right eye quiet; total posterior synechia; lens opaque; eyeball soft; defective P. L.; enucleation advised, but declined. I did not see him again until 'anuary, I893 (two years later), when I treated him for suppurative otitis, and again advised enucleation of right eye, V without success. May IS, I893. He comes with irido-choroiditis established in left eye; slight redness; slight photophobia; yellowish exudation on surface of iris and into pupillary space; four-fifths of pupillary edge of iris adherent; vitreous cloudy; R. V. = Preventive enucleation was, of doubtful P. L.; L. V. = t course, no longer possible, nevertheless, as there was no possibility of sight in the right eye, it was enucleated on May I7, i893. rune I, I893. Vision has gone down to 4/200, chiefly by reason of increased opacity of vitreous. OPH.-4
so
WILSON: Sympathetic Inflammation.
On September 8, I893, eye quiet; redness and photophobia gone; L. V.=a2% Feb. 14, 1894. May I I, I894. Mlay i8, 1894. L. V.=L. V.=+ + L. V.= AThe iris has been kept continuously under the influence of atropine, which has been practically the only treatment. He took hydriodic acid for several weeks, but has had none for nine months or more. In place of the excluded case I have taken the liberty to report another, where the question might be raised as to whether enucleation did not cause inflammation in the other eye. MRS. ARTHUR W., age 30, December 6, 1893. -In October, I882, eleven years ago, she first came to me with large central perforation of left cornea, the result of purulent conjunctivitis. At that time a large leucoma formed with complete anterior synechia, and slow disorganization of left eyeball since 1882. This disorganized globe has become red and painful quite a number of times, and that is what she now comes for. December 12, I893. Under leeches, atropine, and hot water, the left eyeball is getting quiet; no symptoms in right; R. V. 2 ° and No. I at 6 in. I next saw her on February io, i894. She has now anotIir attack of pain and redness in left eyeball, and for the first time is willing to consider the question of enucleation. Again under leeches, atropine, and hot water, the eye got quiet, and on February 28, 1894, I enucleated it at the Bridgeport Hospital. The tissues about the ball were more or legs matted together, but the enucleation was easy, and nothing unusual occurred. One maneuver, perhaps, should be mentioned. For a year or more at all my enucleations, just before the dressings were applied, I have flooded the tissues with absolute alcohol - i. e., taking a piece of cotton or gauze saturated with alcohol, with a gentle boring motion I have thrust it to the very bottom of the cavity from which the eyeball came. It has always seemed to me that the healing took place much more kindly. March I, I894. First dressing; wound healing kindly. March 2, 1894, Wound healthy.
WILSON: Sympathetic Inflammation.
5t
March 3, I894 (three days after operation), she was discharged from hospital. Up to the day of operation her right eye was tested, either by my associate, Dr. Miles, or myself, every day, and we always found v3vision and good accommodation, with absence of pain, redness, photophobia, or epiphora. During the four days she was in the hospital her vision and accommodation were not tested, but she did not have pain, redness, photophobia, or epiphora. March 7, I894. During last night pain suddenly attacked right eye. It was severe enough so that her husband gave her two A-grain morphine pills before morning. She now comes to office with pain, redness, photophobia, and epiphora. Her vision is 2; she reads No. i Jaeger at six inches. There is no pink zone over ciliary region; the engorgement is principally of the large blood vessels. There is distinctly more redness over the external rectus than in other parts of ball. This area is also tender to touch, while other parts of eyeball are not. The iris reacts promptly to light; there are no posterior synechiae. In an eye unexposed to sympathetic inflammation, I should have made a diagnosis of episcleritis. March 14, 1894. Symptoms have slowly subsided. The pain has seemed out of proportion to the other symptoms. Hot water fomentations locally and antipyrin in 5-grain doses internally have given her more relief than anything else. March I5, I894. Relapse; eye very red and painful again; kept her awake all last night; slight chemosis; hot water and antipyrin resumed. March 26, I894. All pain has gone; slight redness persists. April 5, i 894. Eye quiet;, vision normal. There are three ways of explaining this case: Ist. That the pain, redness, etc., had nothing to do with the other eye. 2d. That sympathetic irritation started before the enucleation, but was in some mysterious way delayed on the route. 3d. That the enucleation caused the sympathetic irritation. The last seems to me most probable.
