A CASE OF RETINITIS ALBESCENS PUNCTATA. 
{Mooren, Kuhnt.) 
By SWAN M. BURNETT, M.D., Washington. 
Mrs. L. A. B., aged fifty-eight, has of late years enjoyed very 
good health. Formerly, and particularly at the climacteric period, 
she had serious attacks of epistaxis, but these are now much less 
frequent and severe. 
In June last she suddenly noted a dark spot in the centre of 
the visual field of the right eye. The scotoma, when projected to 
the opposite side of the street, was about one yard square, and 
made it impossible for her to distinguish even large objects at that 
distance. Her vision remained in this state for more than a 
month, when the scotoma began to break up, and when I saw her 
for the first time in December, 1882, there was barely a trace of it, 
and vision in that eye was the same as that in the other, namely, 
= £. On examination, the visual field was found to be intact and 
color-perception normal, as in the fellow-eye. 
An ophthalmoscopic examination showed the media to be per- 
fectly clear, but revealed some peculiar changes in the fundus, 
which are indicated in the accompanying diagram. In the 
region of the macula lutea, and occupying the space between 
this and the optic disk, as well as somewhat below the latter, 
there were a large number of very small yellowish-white dots, 
which could easily be overlooked in the indirect method of 
examination. These dots were not always round in shape, 
but frequently oblong, and usually had a sharply-defined out- 
line. They were not evenly distributed over the surface, nor 
were there any isolated areas in which they were thickly studded. 
No abnormal accumulation of pigment was anywhere visible. The 
retinal vessels going to the inner side were normal as to their size 
and course. The vessels going to the other side, however, showed 
Reprinted from the Archives of Ophthalmology, Vol. xii, No. i, March, 
1883. 23 
A Case of Retinitis Albescens Punctata. 
marked alterations. One of the large veins running downward 
became very tortuous toward the end of its course, while a 
smaller one just above it became lost, and its place was occupied 
by a white band similar in appearance to the dots, while 
another (b), running from the upper portion of the disk, became 
at a short distance from its edge a mere thread, to become again 
of its normal size or even larger. One small twig (<r), running quite 
close up to the macula, was very tortuous, and arose abruptly from 
the vicinity of the vessel which had been transformed into the 
white band, no direct connection being found between it and any 
of the vessels in the neighborhood. One small tortuous vessel ran 
from the edge of the disk directly across to the upper edge of the 
macula. 
At the upper outer edge of the disk there was a hemorrhagic 
spot (a), extending about f of a disk diameter into the retina. It 
was pear-shaped, and its head had a white centre. There were no 
other abnormal appearances of the fundus. 
Ophthalmological literature contains but five cases which 
in their general features bear a resemblance to the foregoing. 
The first mention of such appearances is to be found in 
Mooren’s recently-issued “ Ftinf Lustren Ophthalmogischer 
Wirksamkeit,” 1882, p. 216, though the author makes note 
of the fact that Kuhnt had shown him a drawing of similar 
appearances before his own case was put on record. Kuhnt Swan M. Burnett. 
24 
has reported his case in full before the Fifty-fifth Congress 
der Natur-Forscher und Aertze, held in Eisenach—a very 
brief abstract of which is to be found in The Ophthalmic 
Review, vol. i, No. 14, p. 411. 
Besides these two, Hirschberg has reported three others 
in his Centralblatt f. Augenheilkunde, Dec., 1882, p. 330. 
Of these cases I subjoin an abstract, in order that we may 
be able to take a general view of the character of these 
peculiar alterations. 
Mooren’s Case (i).—A man, aged thirty. V= y VF normal. 
Media clear. Hundreds of punctiform pale-white dots, which 
resembled cholesterine crystals, or as if the retina and choroid had 
been punched through. The relatively narrow retinal vessels were 
nowhere covered by the specks, but the latter were pretty evenly 
distributed between the arterial twigs. Disk slightly gray, with 
all the appearances of a past inflammatory process. In six weeks 
with the condition of the retina remaining the same. 
Kuhnt’s Case (2).—The patient was a girl with V=-J-, and 
contraction of VF. Minute white specks on the inner retinal 
layers, and seen only in the erect image. K. reports that he has 
seen two similar cases since the first one. 
Hirschberg’s Case (3).—Woman, fifty-nine years of age. 
Three weeks before had suffered from haemoptysis. Three days 
before he saw her she had sudden impairment of V in A’ eye, ac- 
companied with photopsies. There was atheromatous degeneration 
of the arteries, and palpitation without any valvular trouble. 
Urine free. V= ; central scotoma, but VF not contracted. 
No alteration in disk ; but between m.l. and o.d. numerous small, 
white specks, which had almost a crystalline appearance, and 
apparently lying on the retina. In nine months these changes had 
disappeared, and V= that of the fellow-eye. 
Hirschberg’s Case (4).—A woman, fifty-eight years of age, 
suffering from catarrh and dilatation of the stomach. Heart and 
vascular system normal. Urine free. Small scotoma of 30 in 
centre of L VF. Retinal hemorrhage above the disk 
three or four o.d.’s in size, which H. thinks due to vomiting. 
O.D. normal. V finally became and the changes in the retina 
retrogressed. 
Hirschberg’s Case (5).—Woman, sixty-two years of age. An 
attack of cholera morbus. Suddenly a green scotoma in centre of 25 
A Case of Retinitis Albescens Punctata. 
field of left eye. VF normal; o.d. and vessels also 
normal. Fine points in the centre of the retina. Urine free. 
Six cases do not furnish sufficient data on which to base 
any reliable opinion as regards either the etiology or essen- 
tial nature of the affection ; but it seems to be evident that 
there is no derangement of the general system to which it 
can be referred. In every reported case it was unilateral, 
and the urine was found to be normal in every instance in 
which it was examined. 
The peculiarities of the affection seem to be that the 
alterations are confined almost exclusively, to the region 
between the m.l. and o.d., and are in the retina, and most 
probably confined to the inner layers. 
Vascular disturbances are not always present, but in the 
case reported by me were quite marked ; in fact, all the 
characteristics of a retinitis were more pronounced in this 
case than in any of the others. The central scotoma, which 
was noted in three cases, we can attribute to such an inter- 
ference with the nutrition of the retina in the region of the 
m.l., as to hinder it in the proper performance of its func- 
tion. It may occur at any age, and affects both sexes. 
The prognosis is, as a rule, good—some cases going on to 
complete recovery, while none seem to lead to destruction 
of vision. 
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