The patient was invalided as totally blind (November, 1900).
Mr. Lang, who saw this patient on his return to England, kindly furnishes me with the following note as to the condition. There was extensive damage to both eyes, hæmorrhage, and probably retinal detachment as well as choroidal changes.
The quotation of a few illustrative examples typical of the ordinary orbital injuries may be of interest:—
(77) Vertical wound.—Entry, into left orbit in roof posterior to globe, and internal to optic nerve; exit, from orbit through junction of inner wall and floor into nose.
Complete blindness followed the injury, but upon the second day light was perceived on lifting the upper lid. There was marked proptosis, subconjunctival ecchymosis, swelling and ecchymosis of the upper lid, and ptosis. Anæsthesia in the whole area of distribution of the frontal nerve.
At the end of three weeks, fingers could be recognised, but a large blind spot existed in the centre of the field of vision. The general movements of the globe were fair, but the upper lid could not be raised. The proptosis and subconjunctival hæmorrhage cleared up.
Little further improvement occurred; six months later the patient could only count the fingers excentrically. A very extensive scotoma was present. The optic disc was much atrophied, the calibre of the arteries diminished and the veins full (Mr. Critchett). The ptosis persisted. It was doubtful in this case whether the ptosis depended on injury to the nerve of supply, or on laceration and fixation of the levator palpebræ superioris. The latter seemed the more probable, as the superior rectus acted. The absence of any sign of gross bleeding into the anterior chamber is opposed to the existence of a perforating lesion of the globe in this case.
(78) Entry (Mauser), from cranial cavity, just within the centre of the roof of the right orbit; exit, from the orbit by a notch in the lower orbital margin internal to the infra-orbital foramen; track thence beneath the soft parts of the face to emerge from the margin of the upper lip near the left angle of the mouth. Collapse of globe, proptosis, subconjunctival hæmorrhage, œdema and ecchymosis of lids.
Shrunken ball removed on twenty-fourth day (Major Burton, R.A.M.C.).
(79) Entry (Mauser), at the posterior border of the left mastoid process, 3/4 inch above the tip; exit, in the inner third of the left upper eyelid. Globe excised at end of seven days. Facial paralysis and deafness.