118 Med. Times and Gazette, March 7, 1834.
119 R. L. O. Hos. Rep., vol. iv. pp. 65, 66.
120 Obstet. Trans., vol. v. p. 79 (1864).
121 Handbuch der Augenheilkunde, vol. ii. p. 180.
PUERPERAL PHLEBITIC OPHTHALMITIS.—According to Mackenzie, this dread malady, which, as a rule, causes the death of the patient, may develop at any time from the third to the thirtieth day after delivery. It frequently attacks both eyes, and in those cases which do not terminate fatally eyesight is usually lost. Hall and Higginsbottom,122 Mackenzie,123 Fischer,124 Arlt,125 and Hirschberg126 have all given good clinical descriptions of the disease, with careful autopsies. As in other forms of metastasis, it is ushered in with a chill. Soon after, transient darting pains are felt in the eye, which are sometimes associated with photopsies and followed by serous infiltration of the conjunctiva bulbi. Later, owing to effusion in the capsule of Tenon and to the swelling of the orbital tissues, the eye projects forward and its motility is impaired, these symptoms being accompanied by a clouding of the cornea and the formation of pus in the anterior chamber. If the patient lives, we may have either discharge of pus through the cornea or sclera, or its gradual absorption: in either case, the eyeball shrinks to a small stump. Anatomical examination shows that the starting-point of these symptoms is a septic embolism of either the choroidal or central retinal blood-vessels. According to Hirschberg, "In other pyæmic affections in which the eye is attacked with septic embolism life is dangerously threatened, but there is a larger percentage of recovery with permanent blindness (single or double) than in the puerperal form."
122 Medico-Chirurgical Transactions, 1829, vol. xv. p. 120.
123 Treatise on Diseases of the Eye, London, 1854.
124 Lehrbuch der Entzündungen und Organischen Krankheiten des Menschlichen Auges, 1866, p. 285.
125 Die Krankheiten des Auges, 1863, Bd. ii. pp. 167, 269.
126 Archives of Ophthalmology, 1880, vol. ix. p. 177.