A case of epibulbar echinococcus : with a review of the literature on echincoccus cysts of the orbit / by J.E. Weeks.

  • Weeks, John Elmer, 1853-1949.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A case of epibulbar echinococcus : with a review of the literature on echincoccus cysts of the orbit / by J.E. Weeks. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    any kept in the family with which he resides. Patient presented himself at the clinic at the N. Y. Ophthalmic and Aural In- stitute, on September 14, 1888. Eight days previously he had experienced a slight dull pain in the right eye, and the eye became red. Two or three days afterward the patient saw double when looking downward or to either side. The pain gradually in- creased, and the right eyelids, particularly the upper, became swollen. Very slight headache ; no constitutional disturbance. Status prcesens: The right upper lid is considerably swollen, causing obliteration of the natural depression below the margin of the orbit. The palpebral and the ocular conjunctiva to within about 2 mm of thehnargin of the cornea are injected; a scanty muco-purulent secretion is present. The movements of the globe are restricted in all directions. The margin of the cornea moves to within 4 mm of the outer and inner canthus. Movement up- ward almost normal, but does not go below the horizontal plane. Nystagmus exists in both eyes, and vision has always been below the normal. The present condition is : R V = L V = t\°q- ; ■very little improvement with glasses. R = +T2 ; L = Tn. Aside from a possible slight rarefaction of the choroid, there is no pathological change in the interior of either eye. The right eye is a little more prominent than the left. On palpation over the right upper lid, a firm, elastic tumor is felt, situated in the orbit to the median side of its perpendicular meridian. The tumor moves with the movements of the globe, becoming more prominent jf the cornea is rotated downward. When the upper lid is raised, and the cornea is rotated downward as far as possible, the tumor projects, pushing the fornix conjunctivse before it, and putting the conjunctiva on the stretch. The apex of the tumor extends a little anterior to the equator of the globe, and appears to be about § of an inch wide ; its extent posteriorly cannot be determined. The apex of the tumor at its outer angle presents a yellowish ap- pearance, suggesting the presence of pus ; its inner angle is trans- lucent, and of a bluish tint. Careful testing shows the tumor to be slightly movable on the sclerotic. The nature of the tumor was not at first determined ; as it was attached to the globe it was thought that it might be connected with the interior of the eye, but its slight mobility on the sclerotic, and the absence of intra- ocular changes, excluded this possibility. Its elasticity and the indistinct sense of fluctuation imparted to the finger narrowed the diagnosis down to abscess or cystic tumor. It was thought best to