OPHTHALMOSCOPIC REPRESENTATION OF A CASE OF TRAUMATIC RUPTURE OF THE INFERIOR TEMPORAL VEIN OF THE RIGHT RETINA. By Charles A. Oliver, A. M., M. D., ONE OF THE ATTENDING SURGEONS TO THE WILLS' HOSPITAL; ONE OF THE OPHTHALMIC SURGEONS TO THE PHILADELPHIA HOSPITAL#. ETC. REPRINTED FROM ANNALS OF OPHTHALMOLOGY, Vol. VI., No. 1, January, 1897. Ophthalmoscopic appearance of traumatic rupture of the inferior temporal vein. Reprinted from Annals of Ophthalmology, January, 1897. OPHTHALMOSCOPIC REPRESENTATION OF A CASE OF TRAUMATIC RUPTURE OF THE INFERIOR TEMPORAL VEIN OF THE RIGHT RETINA.* By Charles A. Oliver, A. M., M. D., ONE OF THE ATTENDING SURGEONS TO THE WILLS' HOSPITAL; ONE OF THE OPHTHALMIC SURGEONS TO THE PHILADELPHIA HOSPITAL*, ETC. On the 18th of March, 1896, at 7:30 a. m., a fourteen- year-old apprentice in a machine shop was struck in the left eye with a piece of steel, the actual size of which is shown in the accompanying woodcut. The missile was thrown with but a slight degree of force by a fellow-work- man, who was standing at some twenty-five meter's dis- tance. Numerous brilliant stellate phosphenes were noticed at the time that the eye was struck. These were followed by a temporary obscuration of vision. Upon ac- count of severe ocular pain provoked by movements of the globe, tea-leaf poultices, which gave much relief, were applied by the patient. Previous to the accident the eye was as good as its normal fellow. Fifty hours after the accident I saw him at my clinical service at Wills' Eye Hospital. The lids of the left eye were red and swollen. There was slight tarsal and ciliary congestion and a small area of slight superficial haze in the centre of the left cornea. The pupil, which was two milli- meters in diameter, was one-half a millimeter smaller than that of the other eye. Both irides, which were intact and uninjured, were equally and freely mobile to light- *Read before the 1896 meeting of the American Ophthalniological Society. 2 stimulus, accommodation and convergence. The left iris was slightly hyperemic and there was some ciliary tender- ness. Intra-ocular tension in each eye was normal. Vision in the injured eye was reduced to one-fifth of nor- mal (/K). The power of accommodation in the left eye was as good as its fellow (into 8 cm.), but the region of accommodation was markedly lessened (50 cm. into 30 cm. for the far- point). The ophthalmoscope revealed an extraordinary picture, which was immediately sketched in water colors by Miss Margaretta Washington, of this city. As can be seen in the frontispiece reproduction, there was a dense, irregu- lar subhyaloid hemorrhage, which had escaped and was, at the time of examination, escaping as a series of slow oozes, seemingly independent of cardiac action, from a rupture in the inferior temporal vein at an upward angle just beyond its inferior bifurcation. The blood was dis- posed in irregularly situated clots and layers, the densest massings being those which were furthest down and out. In the macular region there was a stellate and irregularly shaped area, enclosing the fovea centralis at its lower inner part. This area was similar to that which at times is seen in cases where there have been slight though rap- idly-given contusions to the eyeball by blunt instruments. No other gross change in the eyeground could be deter- mined. The fields of vision, beside evidencing an absolute scotoma for both form and color that coincided in relative position with the hemorrhagic extravasation, was concen- trically contracted to about one-half of its normal size. No family or personal history of hemophilia or any dyscrasia could be obtained. The patient was strong and vigorous for his age, and had always been healthy and sturdy. Atropine was used locally, the emunctories were freely opened, and alteratives were given. In seven days' time vision had risen to yv. The pupi] was two-thirds and evenly dilated and the ciliary tender- ness had disappeared. The atropine was graduelly re- duced in strength and frequency until one month had elapsed, when hardly any traces of the break in the venous wall and the resultant hemorrhage remained. At this visit all medication was ordered to be stopped. 3 At present writing, nearly nine months later, vision has risen to full acuity, the same as that with the fellow eye, and accommodative power is normal. All signs of inflam- mation in the anterior segment of the globe have disap- peared. The visual fields carefully taken by one of my assistants, Dr. W. Krauss, fail to give evidence of any scotoma in the left eye except possibly a doubtful les- sening of saturation of color in the position previously occupied by the absolute blind area. The extent of the left fields, however, as compared with those of the right eye, still manifest a slight concentric reduction. The ophthalmoscope shows that the subhyaloid extravasation has gone. The vessel-wall in this situation seems thicker and irregularly opaque. The underlying retinal tissue is dragged into a series of striae, which runs mostly at an angle of seventy-five degrees. In other words, with the exception of these almost indiscernible sequelae, the eye is as perfect as its normal fellow. ANNALS OF OFH'THAkMOLOGY . * « A Practical Journal of OFH'fHSLMOLOGY, EDITED BY DR. CASEY A. WOOD, and a large staff of collaborators. ISSUED ON THE LAST OF JANUARY, APRIL, JULY AND OCTOBER. SUBSCRIPTION PRICE, Per Annum, - - - $4.00 SINGLE COPIES, 1.25 Sample copies will be furnished for 75c. each. Address Subscriptions to JONES H. PARKER, Publisher, . 108 North Fourth Street, St. Louis, Mo.