A CASE OF ACUTE CHEMOSIS 
RY 
SWAN M. HURNKCT, M.D. 
Lecturer on Ophthalmology and Otology in the Medical Department of George- 
town University, Surgeon-in-charge of the Ophthalmic Division Cen- 
tral Dispensary, and one of the Consulting Ophthalmic and 
Aural Surgeons to Providence Hospital, 
Washington, D. C. 
[Reprinted from the ARCHIVES OF OPHTHALMOLOGY, Vol. ix, No. 2, 
* June I, 1880.] A CASE OF ACUTE CHEMOSIS. 
By SWAN M. BURNETT, M. D. 
Lecturer on Ophthalmology and Otology in the Medical Department of George- 
town University, Surgeon-in-charge of the Ophthalmic Division Cen- 
tral Dispensary, and one of the Consulting Ophthalmic and 
Aural Surgeons to Providence Hospital, 
Washington, D.C. 
IN the June number of the Klin. Monatsbl. f. Augen 
heilk, for 1870, Dr. Zehender relates a case of what he 
calls “ acutes Bindehautoedem,” the history of which is 
briefly as follows: 
The patient was a man of 55 years, and a convalescent from an 
attack of left-sided pneumonia. 
On April 6th, in the evening, he was seized with symptoms 
of a severe catarrh, accompanied by headache. The next 
day a considerable chemosis was noted, which increased until the 
conjunctiva extruded like a bladder from between the lids. On 
the 10th it had reached its maximum. On the 12th the oedema 
had entirely disappeared from the left, and on the 14th from the 
right eye, leaving a marked conjunctival injection. 
The only treatment was atropine and rest in bed. There was 
no heart trouble, and no signs of pyaemia. 
As I can find no account of any similar cases in the 
literature at my command, I judge them to be rare, and as 
they are interesting on account of the obscurity of their 
causation, I am led to record a case that fell under my obser- 
vation a year ago, which bears a great similarity to that of 
Zehender just related. 
Reprinted from the Archives of Ophthalmology, Vol. ix, No. 2, June, 
188a 2 
Swan M. Burnett. 
Mr. G. D. M., a young lawyer of 29, small of stature and of a 
nervous temperament, had been studying with undue vigor for 
months past, working, he states, continuously about 20 hours out 
of the 24. . 
Four weeks previously he had a throat trouble, terminating in 
abscess, which was followed by an inflammation of the right eye. 
Some “smokiness” in the vision of this eye caused him to con- 
sult me. V=:f. Externally the eye was normal, but with the 
ophthalmoscope all around the periphery of the choroid of both 
eyes, atrophic spots were seen, and in the vicinity of the macula 
of the R.E. there was an apparent thinning of that membrane and 
a few fine points of pigment. The V.F. was perfect, and both 
eyes were emmetropic. 
Ordered smoked glasses and complete rest. As there was also 
an evident malarial complication, he was ordered good doses of 
quinia. 
On April 29th, three days after I first saw him, I was called to 
see him at his house, he being unable to leave his room. I learn- 
ed that on the previous evening, at 9 o’clock, he had been seized 
with an intolerable pain in the left eye and left side of the head, 
which had persisted throughout the entire night. He had nausea 
and rigors which were apparently nervous in their character, and 
were not followed by any notable elevation in temperature The 
eye was exceedingly sensitive to light, but there was no very con- 
siderable injection of the conjunctiva and the pupil responded 
promptly to light. I ordered opiates, hot applications, and a con- 
tinuation of the quinia. On the morning of the 30th I found the 
lids somewhat red and swollen, and a marked chemosis which was 
almost perfectly clear. The photophobia was the same, but the 
pain was less. On May 1st the condition was unaltered, but on 
my visit on the morning of the 2d I found the photophobia almost 
entirely gone and the chemosis greatly diminished. No pain 
whatever, appetite returning, which before had been lost. Vision 
was not then tested, but on the 5th, when he visited me at my 
office, I found it f. There was a very slight conjunctival injec- 
tion, and the ophthalmoscope showed a slight haziness of the 
vitreous. In the course of a week both eyes had V.=£. 
He now says that the attack in the other (right) eye some weeks 
ago was very similar in its character to this. 
The causes usually in operation for the production of the 
chemotic condition are obstructions of some character to Case of Acute Chemosis. 
3 
the return of blood through the veins, such as inflamma- 
tions of the uveal tract and of the conjunctiva itself. These 
are what Shiess * calls active or inflammatory causes, in con- 
tradistinction to those causes which are unattended with 
signs of inflammation and are called passive, because the 
fluid exudes passively through the walls of the vesssls as in 
ordinary cases of oedema from relaxation of the vascular 
walls. 
In the case just related we have no substantial evidence 
that either one of these causes was in predominant opera- 
tion. That there was not an inflammation of any part of 
the uveal tract of sufficient violence to cause obstruction of 
the venous circulation, is abundantly shown by the fact 
of the abrupt termination of the symptoms, and the want 
of objective evidence. There was some turbidity of the 
vitreous it is true, but that I account for by a condition of 
the interior blood-vessels similar to that of the outer coats 
of the eye which allowed transudation of fluid into that 
cavity. 
It is more than probable, however, that the pathological 
condition of the ant. portion of the choroid played the part 
of predisposing cause, for evidently, judging from the oph- 
thalmoscopical appearances, morbid changes were slowly 
taking place there. These however, were not in and of 
themselves sufficient to cause the circulatory obstruction 
necessary to the chemosis. I look upon the neuralgia of 
the fifth pair (probably of malarial origin), as the exciting 
cause. 
It is well-known that neuralgia of the fifth pair is often 
attended with a hyperaemia of the conjunctiva. Under 
ordinary circumstances, this undue determination of blood 
is carried away by the veins without any serious trouble. 
In this case, however, owing to the diseased condition of 
the ant. portion of the choroid, the veins were probably un- 
equal to the task imposed on them and a chemosis was pro- 
bably the result. At least, I think we are justified in the 
opinion that the condition was due largely to deranged 
vaso-motor influence. 
* Klin. Monatsbl. f. Augenheilk, 1872, p. 1-7.