E. S., aged eleven years. First seen on July 25, 1899.
History.—At 6.45 P. M., on July 24, the patient was struck in the right eye with a cricket ball, made of cork and covered with rag cloth.
Present State.—Right eye: Small abrasion of the skin of the lower lid, with a surrounding area of redness. Some general conjunctival congestion, with a definite ecchymosis in the ocular conjunctiva, opposite the lower-outer quadrant of the cornea. Tension minus 1. The pupil distinctly sluggish and a trifle larger than the other one. Anterior chamber deep. A narrow line of blood clot lay at the bottom of the anterior chamber. V. 5
9 (ii. letters). Pupil dilates imperfectly to a mydriatic. With the mirror alone some parts of the fundus oculi were seen to be unduly white. When examined more closely with the ophthalmoscope there was found a wide but defective zone of whitish fundus, situated peripherally upward, inward, and outward. No such appearances could be made out in the lower part of the fundus. The retinal vessels, which lay anterior to the affected areas, showed no changes. In most places it was possible to get beyond the whitish patches so as to see the edges of the latter. These margins were irregular, and showed white, tongue-like projections running into normal fundus. Some small islands of cloudiness lay, however, beyond the area of general haziness. Around the yellow-spot region was a white radiating appearance, but no definite white mass was present in that place. Left eye: No fundus changes. V. 5
5 (iv. letters). Tension normal.
Treatment.—Vaseline to abrasion of skin of lid; atropine drops (2 grs. to the ounce—to each eye twice a day); rest in bed.
Progress.—July 26. R. V. 5
12; tension still rather low. The blood clot present in anterior chamber and also on anterior capsule of lens renders it difficult to see the fundus clearly; but no white patches can be made out in the fundus.
July 27. A little blood is still present in the lower part of the anterior chamber. The parts of the retina that were milky have resumed almost their natural appearance, and the changes above mentioned are now represented merely by a faint, whitish, ill-defined stippling of the areas in question. Around the yellow spot is a system of fine radiating lines, which extend for some distance into the surrounding fundus. This is doubtless due to œdema of the retina.
July 28. R. V. 5
6 (i letter); tension still slightly minus. Ecchymosis present in ocular conjunctiva, but the blood has disappeared from the anterior chamber. Pupil not so wide as that of the left eye, although atropine is being used to both. Faint cloudiness lower third of the cornea, made up of almost transparent dots, as may be seen with a +20 lens in certain positions of the eye. Fundus changes have disappeared; faint radiating lines, however, may still be seen around the yellow-spot region.
July 29. R. V. 5
6 (ii letter) T—I. Pupil now as large as that of the other eye. Yellow-spot region still surrounded by a wide band of fine, closely set, radiating gray lines. It may be noted that the corresponding region of the left (unaffected) eye is encircled by an ordinary oval reflex.
August 1. R. V. 5
6; (Tn.). A small ecchymosis still present in the ocular conjunctiva on the outer side of the cornea. No blood in anterior chamber; no corneal cloudiness. Radiating appearance still present around yellow spot of fundus.
August 9. R. V. 5
9, L. V. 5
9; (Tn.).