Clinical Notes of a Case of Injury 
Producing as the Most Promi- 
nent Symptom Luxation of the 
Eyeball into the Orbit: (So- 
Called Traumatic Enophthal- 
mos. 
- BY - 
CHARLES A. OLIVER, A. M., M. D., 
PHILADELPHIA, PA. 
Reprint from Ophthalmic Record, January, 1897. ♦CLINICAL NOTES OF A CASE OF INJURY PRODUCING 
AS THE MOST PROMINENT SYMPTOM LUXATION 
OF THE EYEBALL INTO THE ORBIT: (SO-CALLED 
TRAUMATIC ENOPHTHALMOS). 
One of the Attending Surgeons to Wills' Eye Hospital; one of the Ophthalmic Surgeons to the 
Philadelphia Hospital, etc. 
By CHARLES A. OLIVER, A. M., M. D. 
Without endeavoring to solve any problem as to etiology or as to 
condition, and without presuming to venture any new hypothesis, or 
wishing to correlate the present example of this character of disturb- 
ance with some preexisting theory; and, in fact, with no other motive 
than to place a fairly well studied instance of most probably the sym- 
pathetic type of disorder (one presenting a new and a curious symp- 
tom) upon record, in the hopes that its recital may add some additional 
symptomatology to the previous more or less imperfect studies of the 
incomplete variety of the disease-the writer offers the following, at 
least to him, interesting case: 
On the 14th of July, 1892, I saw a 47 year old weaver at my clinic at Wills' 
Eye Hospital for the first and only time. The patient stated that five weeks pre- 
viously he had been struck in the left eye with a shuttle. The eyeball and the 
surrounding tissues had been much inflamed for the first three weeks, during 
which time he had been under professional advice 
Be came complaining of defective sight in the injured eye. Uncorrected 
vision with the right eye equalled one-half of normal, this being accounted for by 
a manifest hypermetropia. Uncorrected vision in the left eye was much lower, it 
equalling one-seventh of normal with the same amount of manifest hypermetro- 
pia. Accommodative play in each eye was normal for the age of the patient and 
the refractive condition. 
Upon monocular exposure, the right pupil, which was round, measured two 
and one-half millimeters in its horizontal meridian, whilst that of the left eye 
under the same condition, had a diameter of four millimeters in the same meri- 
dian. Both irides, which were of good tint, were quite prompt to light stimulus, 
accommodation, and efforts for convergence, the iris of the injured eye being 
possibly a trifle sluggish There was a marked recession of the left globe into 
the orbit, the anterior plane of the cornea being at least four to five millimeters 
behind that of its fellow The lids were slightly depressed and the palpebral 
fissure was about three millimeters shorter than that of the right lids; the opening 
being still further shortened and narrowed when the patient was made to gaze 
straight ahead with the right eye. 
There was almost complete paralysis of the left superior rectus muscle, the 
superior limbus of the left cornea being two and a half millimeters lower than that 
of the opposite eye. Further study of the false and the true projection images 
showed a slight paresis of the left inferior oblique muscle. During these exami- 
nations it was several times noticed that when attempts were made with the two 
♦Paper read before the May, 1896, Meeting of the Section on Ophthalmology of the College oi 
Physicians of Philadelphia. eyes to fix upon a near-object upon the median line, a spasmodic twitching of 
both alae of the nose, which was more marked on the left side, appeared. At 
other times, the clonic spasm of the nasal alae was found to be synchronous with 
a series of rapid movements of the orbicularis palpebrarum, but when the orbi- 
cularis was made to act forcibly, the clonic spasm of the angles of the nose 
stopped, and the nostrils were drawn spastically together. As far as could be 
palpated, there did not seem to be any fracture in the external portions of the 
skull in the region of the eye. 
To ascertain if there were any nasal disturbances the case was sent 
to my friend, Dr. Walter J. Freeman, who, upon the following day 
made a careful examination. His report, under date of the 14th July, 
1892, read as follows: 
"Dear Dr. Olivbr. J. S , whom you very kindly referred, brought me 
your note to day. The nose shows old injury dating back probably many years 
of fracture of triangular cartilage of the septum. The antrum on the left side is 
perfectly free, as shown by transmitted electric light, and there is no collection of 
pus, nor trace of recent injury anywhere. The inferior turbinated body is hyper- 
trophied on the left side sufficiently so to warrant me to inquire as to lachtymation, 
but of that I could get no definite reply. There is general congestion of nose and 
throat." xoxoxox oxoxoxo 
xnxnxnxnxnxQx 
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X 
X X Volume VI. New Series. No. I. q 
□ X x ° □ JANUARY 1897. x 
* * * th r* * * * 
OPHTHrtLnK RECORD) 
"x □ r 1 
X EDITED BY 
X 
Geo. E. de Schweinitz, M. D. F. C. Hotz, M. D. X 
'x of Philadelphia. of Chicago. 
G. C. Savage, M. D. H. V. Wurdemann, M. D. q 
X of Nashville. of Milwaukee. 
X Casey A. Wood, M. D. W. E. Hopkins, M. D. 
X 0 X °f Chicago. of San Francisco. 
John E. Weeks, M. D. H. Gifford, M. D. 
of New York. of Omaha. O 
X 
X T. A. WOODRUFF, M. D. X 
X X Editorial Secretary. 
X | | 110a Reliance Building, Chicago, Illinois. 0 
X 0 
X For Table of Contents and List of Collaborators, see page 1. 
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