JJOMPLIMENTS OF DR. REULING. A CASE OF PSEUDO-CYST OF THE RETINA ENCLOSING A FOREIGN BODY. BY GEORGE REULING. M.D. BALTIMORE, MD. [Reprinted from the Archives of Ophthalmology, Vol. ix, No. i, March, j88o.] A CASE OF PSEUDO-CYST OF THE RETINA ENCLOSING A FOREIGN BODY. By GEORGE REULING, M.D., Baltimore, Md. Mr. Geo. L. B., aet. 18, met, ten years ago, with the following accident: He placed a gun-cap on the piston of a toy-gun, and after re- peated efforts at exploding it, succeeded finally with the unfortu- nate result of having his left eye seriously injured by a small piece of the explosive substance entering the ball. He was treated antiphlogistically at the time by the family physician, and, as no sight was left after the accident, the eye was considered lost. The young man went through a private school and afterward a colle- giate course, almost unmolested from either eye, “ except that the blind eye would occasionally show some redness and suffer with slight lancinating pains.” During the time of graduation, when an extra amount of eye work was demanded of the young student, these attacks of pain and redness appeared quite frequently, and the right eye, which so far had held out most satisfactordy, began to be easily tired from reading ; tears would flow after the least effort, and vision began to be slightly hazy for the distance. At that time Mr. B. consulted me. The left (blind) eye showed the following condition : Vision totally lost, eyeball slightly shrunken, on palpation somewhat softer than normal and slightly painful ; beginning phthisis anterior. Centre of cornea occupied by a triangular cicatrix, to which a small part of the atrophic iris was adherent, a dense pseudo-membrane occupying the entire pupil. An ophthalmoscopic examination was impossible. Diagnosis.—Phthisis bulbi following irido-cyclitis with solutio retinae, most likely caused by the presence of a foreign body within the eyeball. 2 George Reuling. The symptoms of the right eye being sufficiently manifest to be regarded as sympathetic irritation (incipient irido-cyclitis), imme- diate enucleation of the left eye was proposed and executed. The enucleated ball, moderately reduced in size and ten- sion, showed distinct impressions along the recti muscles. It was placed in Muller’s liquid for ten days. A vertical section, made with a razor, exhibited the following highly interesting condition (see figure): Sclerotic and choroid were intact, the retina was totally detached, and formed a complete funnel, the base of which was connected with the great- ly hypertrophied ora ser- rata. This funnel con- tained about one-eighth of the degenerated vitre- ous body, in which, on microscopic examination, a great many cells and fibres of connective tissue were found. A completely round cyst (a in Fig.), the size of a large pea, was sit- uated upon the external surface of the retinal funnel. Its walls were evidently formed by the continuation of the retina, while the base was partially constituted by the thickened hyaloid. In opening the completely closed bag by a transverse section, a light yellowish and thin liquid escaped, and within the cavity, loosely adhering to the inner surface of its wall, a piece of a gun-cap was found. It was triangular in shape, and weighed little over two grains. Examination of cyst.—The wall of the cyst showed slight thickening at the point of fixation of the piece of metal; the latter was not capsulated by newly-formed tissue, but preserved its metallic lustre, and was hanging with a slightly hook-shaped corner on the inner surface of the cyst. The microscopical examination of the cyst itself showed Pseudo-Cyst of the Retina. 3 a total destruction of the cones and rods, while the rest of the retinal layers showed hypertrophic degeneration of its elements with a considerable amount of connective tissue corpuscles and fibres interlacing the granular and cellular layers. In the choroid there was a very small cicatrix situated near the horizontal meridian, 2, 5"' distant from the inner margin of the optic disk.