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• Kumpulan lagu dangdut koplo. 682 NOTES, CASES AND INSTRUMENTS

  ing. This was grasped with a pair of automobile pliers and was readily removed after loosening it with a twisting motion. It was an old rusty knife blade, almost 4 cm. long and 13 mm. wide. There was no reaction in the eye or orbit following the operation, and the wound healed without incident.

  DACRYOADENITIS FOLLOWING BRONCHOPNEUMONIA.

  HOWARD M C I . MORTON, M.D., F.A.C.S.

  M I N N E A P O L I S , M I N N .

  It may be observed, that affections of the lacrimal glands are as infrequent as those of the lacrimal sac and duct are common. The position of the

  Fig. -X-ray picture from side showing relation of blade to cranial bones.

  The presence of a large foreign body transfixing the orbit with symptoms so slight that the patient did not suspect its presence is unusualin fact almost inconceivable. The absence of suppuration in the presence of a dirty, rusty piece of steel is also noteworthy. However, the feature of greatest scientific interest in this case is the rapid loss of vision in the absence of any pathology to account for it. With a normal fundus the assumption that the blindness was caused by an injury to the optic nerve behind the entrance of the arteria centralis retinae, which usually perforates the nerve sheath 10 to 15 mm. behind the eye. seems justifiable, yet the forward position of the knife blade would preclude such a possibility. The blindness and also the paralysis of the extrinsic ocular muscles can perhaps only be explained as resulting from the pressure of a blood clot which formed rapidly at the time of the injury.

  lacrimal gland gives it the fullest measure of protection, and its numerous ducts emptying downward render infection from the conjunctiva less easy. Therefore, it has been observed that infections of the lacrimal gland are usually endogenous rather than exogenous.

  Examination of the literature of dacryoadenitis reveals its infrequency; this applies particularly to bilateral involvement. It is, indeed a rara avis of ophthalmic practice. The case I am reporting is the first that I have met with in my practice. Arlt in his 'Lehr-buch' says that he had never seen a case of dacryoadenitis, and Hirschberg (Arch. of Ophth. Vol. 8, p. 369) states that among 22,500 recorded cases of eye disease, there was but one of suppuration of this gland. In 1886 Powers stated that one case of an abscess of this gland was mentioned in the Royal London Ophthalmic Reports. It is well to note that Cowper in Vol. 5 No. 2 of the Am. Jour, of Ophthal. re-

• NOTES, CASES AND INSTRUMENTS 683

  ports a case of 'Symmetric Cystic Enlargement of the Lacrimal Glands Due to Syphilis.' There was no pain or discomfort, and tenderness or redness were absent. Three or four weeks after one injection of arsphenamin the swelling entirely disappeared. In the case I am reporting there were no symptoms of inflammatory reaction, simply marked swelling under the ex-

  Fig. 1.Bilateral symmetric dacryoadenitis.

  ternal angular process of each eye. The bacteriologic examination was negative, simply revealing a few streptococcus albus and xerosis bacilli.

  The patient consulted me February 16, 1923, and gave the following history: About five weeks previous to this date the family had been driven out of the house by fire. The weather was cold, and the patient in making the necessarily hasty escape was insufficiently clad. There was probably some irritation from smoke. As the result of these causes she developed a low grade bronchical pneumonia. Her physician informs me it was mild in degree, and her temperature did not go above 102. He saw the patient but twice, and she was confined to her bed for two weeks only. At about the time of her recovery, a swelling developed symmetrically, involving about

  the outer halves of each upper lid. She did not come to see me for at least ten days after the appearance of this swelling. She stated that the appearance was very much the same as at the beginning, except not quite so noticeable. She had experienced no pain and had had no discharge from the conjunctivae. She said there had also been an entire absence of any redness or discoloration of the skin over the area of swelling.

  Inspection revealed a bilateral and symmetric swelling situated in the region anterior to each lacrimal gland This was of quite noticeable degree but without change of color of the skin The outer third of each palpebra fissure was narrowed and the sulci be tween the lids and eyebrows was obliterated in the outer half of each lid. There was no dilation of the con-junctival vessels, and eversion of the lids showed no involvement of the accessory glands. There was a normal amount of lacrimal secretion, and the patient told me she had experienced no pain. There was no involvement of the parotid or sublingual glands. Pupils were normal in appearance and reaction. The excursions of the eye were normal.

  Upon palpation of the swollen areas, involvement of the lacrimal glands was indicated by doughy masses projecting from under the orbital ring in the region of the lacrimal fossae. There was no tenderness experienced by the patient during this procedure. There were no signs of a synchronous involvement of the glands of Krause. The upper portions of the tarsal conjunctivae and the fornices appeared normal. The tissues of the lid did not seem to be involved, and it was clearly an involvement of the lacrimal glands alone.

  It is to be recalled that in the peculiar syndrome called Mikulicz' disease, we have symmetric involvement of the glands of the head including the lacrimal glands. One such case reported by Carl Fisher, of the Mayo Clinic, some years ago, before the Minnesota Academy of Ophthalmology, forms the only exception to the previous statement regarding my

• 684 NOTES, CASES AND INSTRUMENTS

  experience with bilateral involvement of the lacrimal gland. Dewatripont, in La Clinique Beige of Oct. 28, 1911, reports four cases of suppurative inflammation (monolateral), in which the only organism was the pneumo-coccus. He states that after the phleg-

  Fig. 1.Phoria indicator on black cabinet.

  monous inflammation set in, this organism was replaced by the streptococcus, and that these four cases arose from nasal origin.

  HETEROPHORIA AND ASTIGMATISM CHARTS.

  L. WEBSTER FOX, M.D., LL.D. P H I L A D E L P H I A .

  There is nothing new or novel in this combination phoria chart with astigmatic chart. It does, however, make a most useful and attractive addition to the paraphernalia of the

  f ophthalmic surgeon's consulting room. i This Prentice Phoria indicator (Fig. , 1.) is placed flush with the front sur-e face of lid on a black cabinet. The I cabinet is vertically positioned on a - telescoping rod with base. This tele-- scoping feature permits the operator

  i I

  Fig. 2.Reverse of cabinet showing astigmatic chart.

  to raise and lower the apparatus to a point exactly on a level with the patient's eyes. The discs of light are arranged like a Greek Cross with the central light red, and from it radiating vertically and horizontally, one degree prism angle apart, are green lights, five-eighths of an inch in diameter. These discs of light are controlled by a switch at the examiner's table. When great accuracy is required, a Maddox Rod is placed before one eye, and at once the phoria defect is ascertained.

  On the reverse side of this cabinet (Fig. 2.) we have placed an astigmatic

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