A REMARKABLE CASE OF DETACHMENT OF 
THE RETINA, WITH HEMORRHAGE INTO 
THE SIMULATING INTRA-OCULAR. 
BY 
DAVID WEBSTER 
NEW YORK. 
[Reprinted from the Archives of Ophthalmology, Vol. ix, No. 3. 
Sept. 1, 1880.] A REMARKABLE CASE OF DETACHMENT OF 
THE RETINA, WITH HEMORRHAGE INTO THE 
VITREOUS, SIMULATING INTRA-OCULAR TU- 
MOR. 
The’ patient, a maiden lady, aged 27, about June 1, 1876, be- 
came conscious of some trouble with her vision. She closed one 
eye and then the other, and so discovered that her right eye was 
almost blind. There were no premonitory symptoms, no accom- 
panying pain, photopsise or chromopsiae. What little remained of 
sight gradually disappeared, and when I first saw the lady on the 
nth of the following August, there remained no perception of 
light. There was not then, nor had there been, any redness or 
other external symptom. Examined with the ophthalmoscope, 
the pupil dilated by atropine, the reflex was totally black, except 
a small reddish area at the lower border of the lens and extend- 
ing up behind it to the extent of about a millimetre. Oblique 
illumination showed the same appearances. The tension was 
about normal. 
The eye was kept under observation until January 24, 1877, a 
period of a little over five months, during which no change 
occurred, except that the reddish area gradually crept up behind 
the lens until it covered the lower half of its posterior surface,, 
and gradually increasing pressure in the vitreous chamber so' 
caused the lens and iris to advance, that the anterior chamber be- 
came very shallow. The patient was seen in consultation by 
Drs. Roosa, Pomeroy, Agnew, and others, but none of us were 
able to make a positive diagnosis ; all agreeing that we had to do- 
with either a case of intra-ocular hemorrhage, with detachment of 
the retina, or a case of intra-ocular tiwior, with detachment of the 
Reprinted from the Archives of Ophthalmology, Vol. ix, No. 3, Sep- 
tember, 1880. 2 
Case of Detachment of the Retina. 
retina, and all agreeing that it would be the part of prudence to 
enucleate the eye. This was accordingly done, and the eye placed 
in Muller’s fluid. 
Dr. E. A. Maxwell, who, at the proper time, examined it macro- 
scopically and microscopically, has made the following report : 
Macroscopic Examination. 
External appearances normal. Section made in hori- 
zontal meridian. Measurements in antero-posterior and 
transverse diameters, each seven-eighths of an inch. Retina 
completely detached. Crystalline lens pushed forward, 
almost obliterating anterior chamber, the remains of which 
are only about one line in diameter. The vitreous chamber 
is occupied by a conical blood clot, extending from the 
posterior surface of the lens to the back part of the eye. 
At the equator the clot measures five-eighths of an inch, 
leaving one-eighth of an inch space 'on either side for 
altered vitreous. The clot is covered on its outer surface 
by the detached retina. It is apparently composed of two 
portions, the older coagulum, partially decolorized and strati- 
fied, occupying the outer and posterior portions of the clot, 
while the central and anterior portions are dark and 
soft. The appearances of the stratification of the clot, 
and the more recent hemorrhage, point to the vicinity of 
the ciliary region as the seat of hemorrhage. 
Microscopic Examination. 
Sclera, optic nerve, cornea and lens show nothing of note. 
The choroid, excepting the lacerations of its internal layers, 
and its hyperaemic blood-vessels, appears comparatively 
normal. The retina may be said to be almost completely 
disorganized. Its ultimate structure is scarcely recognizable. 
It is thickly infiltrated with myriads of small round lym- 
phoid or inflammatory cells, a few wandering or pigmented 
cells from the choroid, and contains numerous small hemor- 
rhages. Its external surface has portions of the internal 
layer of the choroid adherent to it, and to its inner surface 
the blood clot is adherent. This condition is general, but David Webster. 
3 
most marked anterior to the equator. The remains of the 
vitreous contains disseminated blood corpuscles. The ciliary 
body shows markedly hyperaemic blood-vessels, occasional 
small hemorrhages, and numerous inflammatory cells in the 
interstitial tissue. The iris, except its ciliary border, seems 
normal.