A CASE OF DOUBLE COLOBOMA OF THE 
CHOROID. 
By C. A. VEA$EY, M.D., Philadelphia, Penn. 
(With an ophthalmoscopic drawing in the text.) 
following case of coloboma of the choroid, which 
seems to possess some points of interest peculiar to 
itself, presented the following history : 
A. S., female, aged twenty-four, came to me for the treatment of 
a variety of symptoms which she attributed to her eyes. For 
several years she had had frequent frontal and occipital headaches 
accompanied by nausea, and occasionally by vomiting, always 
aggravated by doing any near work. The headache was very 
severe, and the patient stated that almost every week she was 
obliged to spend one day in bed on account of it—usually a day 
in the latter part of the week. There were also present symptoms 
of accommodative asthenopia and ciliary pain. She had been 
wearing sphero-cylindrical lenses for three years, with relief of 
the symptoms for one year after they were obtained. The family 
history was good. Both her parents and herself denied having 
had any specific lesion. The general health was very good ex- 
cepting the disturbance arising from the ocular symptoms. The 
vision and accommodative power were as follows : 
O.D.V. jbj Jager, No. 2 3"-28" 
O.S.V. t5j Jager, No. 2 5"-10" 
After she obtained her correction, which was as follows,; 
O.D. -j- S. .75 DC + C. .75 D. ax. 90° 
O.S. -f- S. 1.25 D. 3 + C. 1.75 D. ax. go° 
the vision was for the right eye -f full, for the left eye f- partial, 
the best working distance being 16". 
Reprinted from the Archives of Ophthalmology, Vol. xxiv., No. 2, 1895. 203 
Double Coloboma of the Choroid. 
The tests for muscular balance showed no trouble in this direc- 
tion. Both pupils were normal, reacting quickly to light, conver- 
gence, and accommodation. The tension was also normal and 
the ophthalmoscopic changes were as follows : 
O.D.—Media clear, disc oval, deep central physiological cup, 
absorbing conus to the nasal side of disc, cilio-retinal vessel to 
the temporal side about the junction of the upper and lower 
quadrants, choroidal ring all around, no macular disturbance. 
O.S.—Media clear, oval disc, deep central physiological cup, 
choroidal ring all around, veins slightly fuller than normal, but 
blood apparently not darker than usual. About the distance of 
two thirds of the diameter of the disc below it and slightly to the 
nasal side, is a small circular coloboma of the choroid, greenish- 
white in color, which is about two thirds as large as the disc itself. 
The margin is pigmented all around while the bottom shows 
numerous elevations and depressions, presenting an opalescent 
appearance, and having on its surface two scleral vessels, the one 
to the temporal side sending off a branch. The depth of the 
coloboma varies from i to 2.50 D. in different parts. Passing 
over it from above downward is the inferior nasal artery. The 
surrounding choroid is in a perfectly healthy condition. 
About the distance of two diameters of the disc below the colo- 
boma just described is a second, oval in shape and much larger 
than the former, measuring, as nearly as could be ascertained, 
about 11 X 2J diameters of the disc and being slightly narrower 
in the lower than in the upper half. The margin of this also is 
pigmented, much more heavily in the upper than in any other 
part, and the color, as in the first, is of a dirty greenish-white. 
The coloboma, in the upper outer portion and in the lower inner 
portion, slopes gradually from the margin towards the centre, 
while in the other parts the edge is more abrupt. The bottom 
presents numerous small elevations and depressions and has 
an opalescent appearance like the first, the depth varying 
from 2 to 5 D. The inferior nasal artery that passes over the 
upper coloboma from above downward continues its downward 
course, passing beneath a branch of the inferior temporal vein 
and crossing the lower coloboma in a curve, sending off a branch 
just before it reaches the lower margin. The branch of the in- 
ferior temporal vein just mentioned passes over the edge of the 
coloboma above, dipping beneath it so as to be entirely lost from 
view, and then, reappearing near the middle of the outer edge, 
passes downward and outward. Coming from beneath the upper C. A. Veasey. 
204 
outer margin is a scleral vessel which sends two branches down- 
ward, one to the temporal and one to the nasal side, both being 
lost under the margin. Above and to the nasal side of the lower 
coloboma the choroid is distinctly thinner, though in all other 
directions it appears to be in a healthy condition. The accom- 
panying illustration made from a water-color sketch by Mr. T. C. 
Lander of this city, shows very well the condition of the fundus. 
The field of vision shows a scotoma for form and colors of 
the exact shape of the smaller coloboma, the larger one being so 
far in the periphery that it is indicated in the field only by a curve 
in the upper edge. 
The defects are believed to be congenital, an examination by 
my friend, Dr. Edward Jackson, over three years ago revealing 
practically the same condition. No other congenital defects 
could be found in the patient, and an examination of the father 
and a sister showed nothing more abnormal than low refractive 
errors. 205 
Double Coloboma of the Choroid. 
The case presents the following points of interest: 
There are two separate colobomata of the choroid with a 
wide area of intervening healthy choroidal tissue, in which 
the field of vision is perfectly normal. Cases have been re- 
corded in which a large coloboma was divided into different 
parts, as, for example, the case of Hirschberg, quoted by 
Bock1 in his excellent monograph, where the coloboma was 
divided into three parts, while in the middle ran a thin strip 
of choroidal tissue ; or Hoffman’s2 case, in which there was 
an intervening space of healthy choroidal tissue, but which 
was no wider than two thirds the diameter of the small colo- 
boma, the latter being about half the size of the disc ; but 
the author has been unable to find any case recorded in 
which the colobomata were so widely separated, and in 
which so much of the intervening choroid was in a healthy 
condition—in the present case the whole space, with the 
exception of a slight thinning above the lower coloboma, 
being normal. 
The shape of the defects is of interest, the upper being 
circular and the lower oval. The visual field shows a sco- 
toma corresponding in shape to the upper coloboma, and a 
curve in its upper margin corresponding to the margin of 
the lower coloboma. This agrees with the observations of 
Schmidt-Rimpler3 and De Wecker,4 though Johnson 6 
claims that it is very seldom that the field shows a defect 
even slightly resembling the outline of the defect in the 
choroid. 
It is also of interest to note that the choroid below the 
lower coloboma is in a normal condition. The defect is 
supposed to be due to the non-closure of the ocular fissure, 
but why it should have closed in certain parts and not in 
others, or why, if it were entirely closed, it separated above 
and below, leaving so wide a space perfectly healthy in 
almost the entire extent, is only a matter of conjecture. 
1 Bock, Die Angeborenen Kolobome des Augapfels, p. 95. 
2 Graefe-Saemisch Augenheilkunde, p. 73 
3 Schmidt-Rimpler, Graefe’s Arch., xxiii, 4, p. 176. 
4 De Wecker et Landolt, Traits Complet. d'Oph., vol. ii., p. 515. 
6 Johnson, Arch, of Oph., 1890, p. 28.