CLINICAL CONTRIBUTIONS TO OPHTHALMOLOGY. 
P. D. KEY SEE., M.D., 
OF PHILADELPHIA. 
(From the Medical a.nd Surgical Reporter, July 18, 1874.] 
Perforating Wound of the Sclerotica, Partial 
Detachment of the Iris from its Ciliary 
Border, and Rupture of the Choroid. 
Recovery of good Vision. 
moscopie examination shows quite a peculiar 
and extended rupture of the choroid. A yellowish 
white band is seen starting out just above the 
optic disc, rising in a curve forming an arch 
across the top of the disc, then falling down in a 
curve to a little distance below the lower edge 
of the papilla, along; the line of which the 
edges of the ruptured choroid can be plainly 
distinguished. For some distance around the 
rupture there is a choroidial hemorrhage which 
can be well mapped out. 
On the 9th of September, 1873, a boy threw 
quite a large piece of hard mortar at David C., 
aged 15 years, of Wilmington, Del., striking 
him on the left eye, knocking him down sense- 
less for a short time. He was carried home to his 
bed, where he lay for two days, unable to raise 
his head in the least without retching and 
vomiting taking place. The lids of the eye be- 
came immediately so swollen that they could 
not be opened for five days after the injury, so 
that no examination of the condition of the eye 
was made. The lids were not in the least in- 
jured from the blow. Cold water cloths were 
continually laid over the eye until the swelling 
was all gone, when he was sent to me, nine 
days after the injury, iu the following condi- 
tion : 
See accompanying figure. 
Lids free from any swelling, open well and 
freely; ocular conjunctiva somewhat injected, 
particularly peri-corneal. About 3 to 4 m.m. 
inside of the edge of the cornea there is a ver- 
tical incision in the sclera, of 3 to 4 m.m., which 
is in fine process of healing. The upper part 
of the iris is torn away from its ciliary attach- 
ment and falls a little down, causing the top of 
the pupil to be straight instead of arched. The 
anterior chamber and pupil are perfectly clear ; 
all hemorrhage which must have been there 
was entirely absorbed. Vision *. No pain 
either in the eye or over the brow. Opbthal- 
The retina is in proper position, the vessels 
running over the ruptured choroid in their 
normal condition. There is no effusion into the 2 
vitreous. The artificial leech was applied to the 
temple, the cold water applications over the 
eye still continued, and iodide of potassium given 
internally. 
Aug. 14, 1873. A new deposit of crystals has 
begun to form in the same place from which the 
above was removed. lie was admitted this day 
into the hospital, for observation. 
October 9th, The wound in the sclera is com- 
pletely healed; the ocular conjunctiva has the 
normal healthy appearance. The hemorrhage 
around the rupture in the choroid much lighter 
in color and reduced in size. The ruptured 
edges sharp and well defined. Vision improved 
to and reads No. 13 Jager's test types. 
September 2,1873. It has increased to about 
the size of the previous one, so I determined to 
remove it for chemical and microscopical exami- 
nation. 
On account of the very great sensitiveness of 
! the eye, the patient was etherized. The crystal 
was delicately lifted off, after which I examined 
the diffused translucent infiltration in the cornea, 
and found it to be just under the epithelium, 
and would scale off in thin broad plates. I 
removed it all. By chemical examination it was 
found to contain phosphate and carbonate of 
lime. The larger and thicker deposit was 
found, under the microscope, to he, like the first 
one, a collection of small transparent and semi- 
transparent crystals, 1 m.xn. long by 0.50 m.m. 
wide. While under the anaesthetic the fundus 
of the eyo was examined with the ophthalmo- 
scope. The cornea not being perfectly transpa- 
rent, a perfectly defined view could not be ob- 
tained. However, two irregular light pinkish 
spots or plaques could he discovered in the 
choroid. There were no collections of pigment 
around them, or anywhere to be seen. They 
had not the appearance of inflammatory or of 
atrophic spots. Acid treatment Avas ordered. 
Sulphuric acid given internally, and the cornea 
touched daily with acetic acid diluted. 
November 10th. Choroid has still a more nor- 
mal appearance. Vision increased to 2® and 
reads No. 5 Jager’s types. 
December Istb. Choroidial hemorrhage all 
absorbed. Vision still improving 20 reads No. 4 
Jager’s types. Was now allowed to return to 
school. 
Fhosphatic Degeneration of the Cornea. 
D. M., aged fifty-three years, came to my 
clinic at the Wills’ Eye Hospital, February 25th, 
1873, complaining that with the left eye “he 
could not stand the light, move the hall, nor 
open the lids, Avithout a great scratching pain.” 
On opening the lids to examine the eye no in- 
flammation of the conjunctiAra of either the lids 
or bulb, nor peri-corneal injection, was present, 
but a translucent infiltration Avas seen running 
in a horizontal line across the centre of the cox*- 
noa, from the inner to the outer edge, and com- 
pletely covering the pupil. The opacity Avas of 
cone shape, with the base at the inner edge and 
apex at the outer one. On the upper edge or 
line, immediately over the upper border of the 
pupil, there Avas a point slightly raised and of 
a shining crystalline appearance. There is an 
utter impossibility to open the lids without 
pain from the light, and a feeling as if a foreign 
body Avas in the eye. 
November 1, 1873. Under the acid treatment 
the eye has improved daily. The cornea is 
clearing. Being nearly transparent over the 
pupillary region. , 
January 1, 1874. Still improving •, can open 
the eye freely and steadily. The light does not 
affect it. 
The history given was that the vision had 
been getting dim for some time hack, but had 
had the photophobia only a few Aveeks previously 
to his presenting himself at my clinic. He has 
suffered ranch from rheumatism in the hips and 
back at times, otherwise health}'. Had been 
infected with syphilis some twelve or fifteen 
years ago. 
March 1, 1874. Returned with the scratching 
feeling again. A new plate of crystals is 
forming in the ioAver line of the pupil. 
April 7, 1874. Removed the plate, and 
placed it under the microscope for examination, 
when it was found to be the same as the pre- 
vious ones, above described. 
To remove the scratching feeling, I lifted the 
crystalline point off with a needle, which gave 
instant relief. Placing this under the micro- 
scope, it showed itself as a collection of beauti- 
fully formed small, transparent and semi-transpa- 
i*ent crvstals 1 m m long by 0.80 m.m. Avide. 
The only case I know of, of this nature, is 
mentioned by Bowman, in his lectures, of one 
in which “he removed from under the epithe- 
lium of the cornea a deposit of a salt of phos- 
phate and carbonate of lime, which had formed 
in the course of several years without any in- 
flammatory action.” 3 
Glancoma Simplex, with a Diffused Brown 
it could not be well distinguished over the 
Infiltration in the Cornea.—Absorbed 
after Iridectomy. 
pupil and naturally dark hazel iris, on ac- 
count of its color being of the same tint. The 
right eye was found normal; vision > 110 in- 
crease in tension. 
Some peculiar forms of cloudiness of the cor- 
nea have been noticed in cases of glaucoma, 
supposed to have been caused by the intraocular 
pressure. Y. Graeffe, in his writings in the 
Arc-hivfur Ophthalmologic, speaks of two dif- 
ferent forms that may be seen in connection 
with secondary glaucoma. The first of which is 
a sclerous infiltration, which is not relieved by 
iridectomy. The second is a circumscribed 
rectangular ribbon-form opacity. Schiess- 
Gemuseus, in the Klinische Monatsbldtter fur 
Angenheilkunde x Jahrgang, p. 332, describes 
another form, “ being a uniform cloudiness 
spreading over the whole of the cornea, without 
any change in the epithelium, as in diffused 
keratitis,” which he observed in a case of glau- 
coma. simplex. 
November 4, 1873. Complained that the 
vision of the right eye was not so clear as it 
formerly was, and that she had suffered pain 
in both eyes at times since she last consulted 
me. The pupils of the eye were somewhat 
dilated. The tension had increased in either 
ball to T-j-2. There was no peri-corneal injec- 
tion. With the ophthalmoscope the central 
artery of the retina in the right eye was plainly 
seen pulsating, but the optic nerve was not 
cupped. Yison reduced to 20L. The field of 
vision somewhat reduced in the inner and 
upper side. The fundus of the left eye could 
not be distinguished. The brownish infiltration 
in the cornea somewhat denser, and could be 
seen more distinctly than when first examined. 
As these cases are rare and of importance, I 
present the following case that came under my 
observation, as being still another now form of 
infiltration in the cornea in glaucoma which was 
entirely absorbed after the operation of iridec- 
tomy. 
Vision l2|x. 
The increased tension, pulsating artery and 
decrease in the field of vision being marked 
symptoms of glaucomatous trouble, an early 
iridectomy was recommended, which I made the 
following day. 
Mrs. A., aged forty-four years, consulted me 
October 11th, 1872, about a mist or cloud before 
the sight of the left eye, which had been trou- 
bling her since the recovery from an attack of 
variola the June previous. From outward 
appearances, at first glance, nothing could be 
seen to indicate any disease of the eye. There 
was no inflammation of the conjunctiva, no peri- 
corneal injection, no pain, nor had there been 
any during the attack of variola. The surface 
of the cornea had its natural shining appearance. 
The vision was found to be reduced to 2®. The 
tension of the ball was considerably increased, 
T-fl. The fundus of the eye could not be de- 
fined with the ophthalmoscope, as there was a 
thin brownish tinted cloud in front. By minute 
examination this cloud was found to be a brown 
colored infiltration spreading in the centre of 
the cornea, while the periphery was still clear. 
By concentrated light from a convex lens 
November 5. The patient being well ether- 
ized, a large iridectomy was made in the upper 
section on either eye. There was no hemorrhage 
into the anterior chambers. Both healed well 
in a short time. 
November 15. Tension cither eye normal. 
Vision right eye x2ox. Left eye, the cloud still 
before it, but less dense. 
December 1. The infiltration in the cornea 
of the left eye nearly all absorbed . Vision this 
eye ». 
December 17. The cornea of the left eye 
perfectly clear. Vision Bight eye, vision 
x^x . The fields of vision normal. From the ab- 
sorption taking place so readily and completely 
after the iridectomy, there is no doubt, in this 
case, that the corneal infiltration was caused 
in some way or another by the increased intra- 
ocular pressure.