AFFECTIONS OF THE EYE APPARENTLY DEPEND- 
ENT UPON UTERINE DERANGEMENT. 
BY 
RICHARD H. DERBY, M.D. 
( With three illustrations.) 
Reprinted from N. Y. Eye and Ear Infirmary Reports, Jan., 1894. AFFECTIONS OF THE EYE APPARENTLY DEPEND- 
ENT UPON UTERINE DERANGEMENT. 
By RICHARD H. DERBY, M.D. 
{With three illustrations.') 
" I" HAT certain disturbances of vision have their origin in 
diseases of the uterus and irregularities of the menstrual 
function, has been well established by competent observers. 
Especially has Mooren, in his Visual Disorders and Diseases of 
the Uterus, drawn attention to this causal relation, and more 
recently, in an exhaustive monograph entitled The Uterus and 
the Eye, has Dr. Salo Cohn written upon the same subject. 
Ophthalmic literature of the last few years contains much from 
other authors bearing upon this matter. Finkelstein wrote 
" On Sensory Disorders in Diseases and on Changes of the 
Field of Vision in Menstruation"1 ; Fitzgerald, "On the Con- 
nection between Diseases of the Eye and Affections of the 
Sexual Organs in Females'" ; Hirschberg, " Ueber Puerperale 
Metastatische Ophthalmic "3 ; Mackay, " Eye Diseases from 
Suppression of Menses "4 ; Thaon, " Des Affections Oculaires 
Liees a la Menstruation " 5 ; Hutchinson, " Failure of Sight 
during Lactation, and its Meaning as a Symptom."6 
This brief enumeration of a few of the many contributions 
which competent observers have made to medical literature 
upon this subject will serve as an introduction to the present 
paper. The writer does not claim that in all the cases which 
1 Ophthalmic Review, vi., No. 73, 1887. 
' Lancet, 1883, i., p. 456. 
' Berliner klin. Wochenschrift, 1880, No. 8. 
4 American Journal of Medical Science, 1882, p. 383, 
5 These, Paris, 1879. 
8 Ophthalmic Hospital Reports, vii., p. 38, 1873. 
Reprinted from N. Y. Eye and Ear Infirmary Reports, Jan., 1894 13 
AFFECTIONS OF THE EYE. 
he here presents an absolute causal relation between the visual 
derangement and the anomaly of the genital function has been 
established. A strong probability that such a relation existed 
has led him to think that the narration of the cases would be of 
interest. If this publication serves to stimulate others, either in 
gynaecological or ophthalmic practice, to make public their 
observations in this direction, the purposes of the present 
contribution will be amply justified. 
Case I.-Patient, R. R., a girl of eleven, large for her years, 
has grown excessively of late and her form maturing, has never 
yet menstruated, came under observation March 3, 1888. She 
states that this morning, on waking, the edge of the door looked 
indistinct. She closed the right eye, and all objects seemed in 
a gray mist, a condition that partially disappeared as the day 
FIG. I. 
wore on. There is a central scotoma of left eye (Fig. i). 
Vision less than .2. The ophthamoscope shows nothing. The 
right eye vision 1, and emmetropic. DERBY 
14 
March x^th.-Condition unchanged. 
March igth.-With + 2.5 D reads Sn. No. 9, and sees move- 
ments of hand over the periphery of the field. There is of this 
left eye a light neuro-retinitis. 
March 2%th -No vision of left eye beyond perception of 
light outwards. There is a well-marked optic neuritis, the 
most prominent niveau of the papilla well seen with + 7 D. 
Mercurial inunctions and increasing doses of iodide of potash 
were ordered. She complains of pain in the eye, occasionally 
of a sense of rush of blood to the head, of palpitation of the 
heart, of headache. This condition of the vision lasted until 
April 4th, and the vision remained practically nil. The mother 
reported not infrequent hysterical attacks. 
April cyth.-Movements of the hand were seen over the entire 
periphery of the field. 
April i^th.-She counts figures outwards. 
April \6th.-She sees Sn. Ixx held a foot away, and move- 
ments of the hand over a broad peripherical zone of the retina. 
The outer limit of the papilla is now clear, the vessels less 
injected, and the most prominent surface of the nerve is seen 
clearly with -|- 3 D. 
April 2gth.-Vision is .1. 
May 2d.-Vision .2 ; reads De Wecker 7. 
May yth.-No demonstrable scotoma. 
May gth-Reads De Wecker 1 close at hand. Vision .4. 
d/hy 19Z/Z.-Vision is .6. 
From this time the improvement of the vision went on until 
it became normal, and the ophthalmoscopic picture of a 
neuritis cleared up. Early in the summer the patient was seen 
again. The general health was excellent, the menstrual 
function was established in July. 
A. v. Graefe drew attention to the fact that neuro-retinitis, 
dependent upon menstrual derangements, was not uncommon. 
Leber found inflammation of the optic nerve in cases where 
the first appearance of the catamenia was delayed, or remained 
absent altogether. He refers to a case 1 especially interesting 
in this connection : A girl of eighteen, with imperfectly 
developed genital apparatus, had never menstruated. She had 
simple optic nerve atrophy, possibly in consequence of a retro- 
bulbar neuritis. The disease had developed with headache, 
dizziness, abnormal tendency to sleep, and weakness of 
memory. The one eye was amaurotic, the other highly ambly- 
1 Handbuch der gesammten Augenheilkunde, v., pp. 817 and 818. 15 
AFFECTIONS OF THE EYE. 
opic, and with marked limitation of the field. Under treat- 
ment the general symptoms subsided, but sight was ultimately 
completely lost. 
Case II.-Annie H., aged twenty-three, single, came to the 
Infirmary February 22, 1893. During the last menstrual 
period, eight days ago, patient, while at work, felt as if some- 
thing swept forward and back in front of left eye. The 
previous evening she had gone out in thin shoes, and exposed 
herself in very inclement weather. During this entire men- 
strual period she had headache, a thing unusual with her. The 
vision of the left eye was reduced to .1. There is a marked 
FIG. 2. 
increase in the size of the blind spot (see Figure 2). In the 
centre of the field was dimness, but no demonstrable scotoma. 
In the region of the macula there was oedema and exudation, 
directly below it a fresh hemorrhage in extent equal to the 
diameter of the disc. The fellow eye was normal in every 
respect. Patient failed to return after this first visit, and no 
further notes of the case were made. DERBY 
16 
Case III.-Emily M., aged twenty-two, single, came to the 
Infirmary October 28, 1892, with the following history : Yester- 
day morning she was " dazed " in front of her right eye, and 
she could not see clearly, then a black spot appeared in front 
of this eye, and remained. Her vision had previously always 
been good. When seen patient was in the midst of her men- 
strual period, which had lasted for two weeks, longer in dura- 
tion and with greater loss of blood than before. There had 
been no headache. There was a large central scotoma, and 
patient counted fingers excentrically outwards. The ophthal- 
moscope showed emmetropic refraction, there was a fresh 
arterial hemorrhage above the papilla, and equal to it in extent. 
The disc was congested, and its outlines hazy. Patient was 
taken into the Infirmary, and put to bed. Dry cups were ap- 
plied to temple and back of ear. 
November 2?>th.-The hemorrhage had largely disappeared. 
There was a circumscribed retinal separation below the disc, 
and not extending within two diameters of it, to the nerve. 
Corresponding to this there was upward visual-field defect. 
Vision .2. 
December 2^th.-Having in the meantime returned to service, 
patient reported that she had been able to read with this eye. 
The vision was normal, and neither the hemorrhage nor the 
retinal separation was demonstrable. No visual field defect 
could be mapped out. 
Case IV., taken from my private case-book.-Patient, Mrs. 
L. R., aged thirty-three, came to me January 25, 1893. For 
the last few days, during her menstrual period, she has had 
headache extending from back of the head to her left eye. 
This occurred especially in the morning, and disappeared after 
drinking a cup of coffee. There was no nausea, no dizziness. 
Each eye showed hyperopic astigmatism and vision normal. 
February \st.-Patient complained of a cloud before the left 
eye. There was moderate mydriasis of this eye, but both pupils 
responded promptly to light. The vision of the left eye was 
now .2, and could not be improved by glass. The vision of the 
right eye normal. There was a scotoma (Fig. 3) above point 
of central fixation. 
The ophthalmoscope showed a neuro-retinitis. The optic 
papilla (in the inverted image) showed a recent hemorrhage at 
the nerve sheath and infiltration of the retina corresponding 
in extent to the diameter of the papilla toward the macula. 
There were some vitreous opacities. 
Dry cups were applied back of left ear ; mercurial inunctions 
and iodide of potash were ordered. 
February 6th.-The vitreous opacities were less ; vision .4. 
February 2\th.-The scotoma was diminished in extent; 17 
DERBY, 
vision .6. The evidence of hemorrhage at the nerve disappear- 
ing ; outlines of disc more clear. 
March 10th.-Vision 1 (?). 
FIG. 3. 
March 23^.-Catamenia present. Patient thinks her vision 
again less clear. While central vision is still normal or nearly 
so, the scotoma was of slightly greater extent. The ophthal- 
moscope showed no advance in the retinal process. The 
mydriasis of the left eye has disappeared. Ube 'Knickerbocker press 
Hew l?ork