DOUBLE CHORIORETINITIS, WITH PARTIAL 
DEGENERATION OF THE OPTIC NERVE, 
ASSOCIATED WITH CURIOUS LYMPH 
EXTRAVASATION INTO THE 
RETINA AND VITREOUS. DOUBLE CH0RI0-RET1NITIS, WITH PARTIAL 
DEGENERATION OF THE OPTIC NERVE, 
ASSOCIATED WITH CURIOUS LYMPH 
EXTRAVASATION INTO THE 
RETINA AND VITREOUS. 
By CHARLES A. OLIVER, M.D., 
PHILADELPHIA, PA. 
Reprinted from Transactions of American Ophthalmological Society, 1887. DOUBLE CHORIO-RETINITIS, WITH PARTIAL 
DEGENERATION OF THE OPTIC NERVE, 
ASSOCIATED WITH CURIOUS LYMPH 
EXTRAVASATION INTO THE 
RETINA AND VITREOUS. 
J. M., a twelve-year-old school-boy, presented himself at St. 
Mary’s Hospital for examination of the eyes. By careful and 
close questioning no special dyscrasiae could be obtained, the 
family history being exceptionably good. The patient was 
healthy and strong, until five years ago, when he had an 
attack of diphtheria and paralysis, confining him to bed for 
three months, during which time he was unable to speak, and 
his eyesight became bad; this last condition persisting.1 
He was well developed, intelligent, and of good stature. 
All of the obtainable deep and superficial reflexes of the trunk 
and upper extremities were normal. The patellar-tendon re- 
flexes were almost abolished. Physical examination failed to 
reveal any other organic change. His urine was free from 
albumen and sugar, and utterly devoid of any debris except a 
few epithelial scales ; the specific gravity being 1020. 
Both pupils were large (four and a half millimetres in hori- 
zontal diameters, upon exposure to diffuse daylight). The 
irides were mobile to light stimulus and accommodative action, 
but the left iris was sluggish. Centric vision for form with 
the right eye equalled one fiftieth of normal whilst that 
of the left eye was one fifth, doubtful —, the patient giving 
1 Details of the sickness related to me by the attending physician, Dr. W. W. Lamb. 4 
a slight twist of the head to obtain more accurate fixation) ; 
this not being sensibly improved by correction of error of 
refraction. 
The ophthalmoscope showed in the right eye a peculiar 
brilliant lymph extravasation on the retina, extending out 
from the vessel-entrance on the disc to a large irregular area 
of choroidal inflammation ; the mass having a gradual increase 
of elevation and thickness, as if by superimposed layers,— 
similar to those upon the back of an oyster shell,—from one- 
half dioptric at the vessel-entrance on the disc in advance of 
the surface of the disc, to two and a half dioptrics at the sum- 
mit of the pyriform prolongation. The portions of the optic 
nerve in connection with this mass seemed to be entirely 
free from disturbance, until the point of greatest bulk of the 
extravasation was reached, where there was an underlying and 
surrounding area of unequal degeneration of choroid and 
retina, allowing the sclerotic to be seen. The retinal elements 
in the position of the fovea were seemingly destroyed. The 
nerve itself had undergone partial red-gray atrophy, whilst 
the retinal vessels,—especially the veins,—were diminished 
in size. The entire choroid appeared as if “black peppered”; 
this being more pronounced near the area of inflammation. 
The media were clear. Refraction showed a hypermetropia 
of one-half dioptric for the vessels at the long axis of the disc. 
The left eye presented another stage of the same picture. 
The lymph extravasation had evidently broken loose, and was 
floating in the vitreous. It showed the same characteristic 
oyster-shell and silvery sheen-like appearance, but seemed 
smaller and filamentous (Fig 2, Plate 2). The macular region, 
which appeared somewhat lower than usual, was quite inter- 
esting ; the fovea itself had, directly in its centre, a deposit of 
similar material, though somewhat browned, to that seen in 
the vitreous ; this spot being partially bounded by a trace of 
sclerotic. Surrounding this, there was an area of retina, 
which was so thin as to be almost imperceptible, allowing the 
choroid to be plainly visible. This area was equal to the size 
of the macular region, and was utterly devoid of capillarity. 
The entire space was bordered by a well defined line of semi- Plate 1.0. D. 
DFt. P.N.K SCHWENK. DEL. Plate 2. O.S. 
Fig.2. 
LITH. CRAIG,FINLEY fi( CO- 1020 ARCH ST 
PHILADA PA. 5 
transparent retina, which increased in density and thickness 
until it was lost in the general retinal haze. The nerve and 
retinal vessels were almost identical with those in the other 
eye. With the exception of the single vitreous opacity above 
noted, the media were clear. Refraction was the same as in 
the other eye. 
The accompanying chromo-lithographs, which were made 
from water-color sketches by Dr. P. N. K. Schwenk, show 
these conditions very well. 
The case is interesting, not only from an aetiological 
standpoint, where there may possibly have been a basilar 
meningitis with descending inflammation and partial atrophy 
of the optic nerves, with lymph extravasation into the interior 
of the ocular globes, or a localized intra-ocular lesion with 
cell proliferation into the vitreous ; but is worthy of record in 
affording an ophthalmoscopic picture of a pathological change 
which may be considered as illustrative of a histological con- 
dition that is invisible in the ordinary methods of examination 
of the living eye,—that is, the appearance in the macular 
region of the left eye, resulting from the deposition of the 
foreign substance. Plere the damage to the retina and 
choroid has not been so great as in the other eye; this most 
probably resulting from the lesser size of the mass having 
caused a lower grade of inflammatory action with consequent 
slighter plastic attachment. This want of strong attachment 
has permitted the mass to become dislodged and thrown out 
into the vitreous, carrying with it the greater part of the in- 
tervening band between the stump left protruding from the 
vessel-entrance on the disc and the remnant remaining in the 
fovea. The inflammation is, therefore, remarkable in appear- 
ance, it having produced just sufficient change in the macular 
region to allow the resulting condition seen to be used as a 
rough example of what is ophthalmoscopically invisible in the 
healthy eye, and which could only be recognized by much 
greater amplification. This picture cannot in any way be 
presumed to be representative of health, as we are here 
necessarily dealing with practically dead material, but can be 
considered merely as a pathological condition which so closely 6 
simulates the appearance of healthy material under greater 
magnifying power (which has not as yet been applied to the 
living subject), that it may be used as an additional means 
of study of the appearance of normal tissue.