Reprinted from Annals or Ophthalmology, January. 1897. 
A pecUTjar case of sarcoma of the 
CHOROID. 
By G. Griffin Lewis, M. 1).. 
SYRACUSE, N. Y 
Mr. H. C. D,,age 59, white, married, first consulted me on June 15, 
1896, complaining- of an inability to see with his right eye. He gave 
the following history: Four months previous he noticed a blurring of 
the vision in his right eye, which gradually increased but was ac- 
companied by no other symptoms except a slightly dull, aching pain 
in the right temple, which was of an intermittent character. His fam- 
ily history was good, and he had never been sick a day in his life, 
with the exception of an occasional cold, until three years previous, 
when, according to his son, who was the attending physician at the 
time, he suffered from valvular insufficiency of the heart, the action 
of which has ever since been more or less irregular and changeable. 
I also learned from the patient that just after recovering from this 
sickness, while running to a fire one evening, one of the conjunctival 
vessels of the right eye ruptured, producing considerable ecchymosis. 
The tension of the eye balls was normal, the pupillary reflex nor- 
mal in both eyes and his urine normal, but his arteries were athero- 
matous. Examination of the right eye revealed a posterior polar cata- 
ract, which was so far advanced that a view of the fundus with the 
ophthalmoscope was impossible, and the vision in that eye was entirely 
gone with the exception of an ability to distinguish shadows from 
below. He was also unable to recognize reflected light when thrown 
into the eye from various directions, excepting when coming from 
below, a fact which plainly indicated that some pathological process 
had taken place within the fundus. 
Taking into consideration the condition of the patient's heart and 
arteries, and remembering his statement regarding the conjunctival 
hemorrhage, which was, in all probability, due merely to the exertion 
of running, I diagnosed the case as one of intra-ocular hemorrhage 
following cataract. 
The cataract was of rapid development ami was no doubt due to 
mal-nutrition of the lens, caused by some pathological process within 
the same eye, as the lens of the fellow eye was perfectly normal, 
and the intra-ocular hemorrhage evidently did not take place until 
after the cataract was sufficiently mature to shut off the vision, as 
there was no sudden but a gradual loss of sight. 
The vision of his left eye was 18/100, and with a +2.25 S. lens was 
brought up to 18/20. This I prescribed for distant use. together with 
a +5.00 S. for reading. 
On August 6th, three weeks later. 1 was called to his house and 
found him suffering considerable pain through his right temple and 
on top of his head. His pulse was only 48, the lids of his right eye 
were badly swollen and the ocular conjunctiva so oedematous that it 
overlapped the cornea around its whole circumference. This attack, 
1 was informed, had come on suddenly with pain from the begin- 2 
ning. The tension was considerably increased, and, concluding that 
he had had another intra-ochlar hemorrhage, I applied leeches to the 
temple, instilled a two-grain solution of eserine sulphate, ami applied 
locally lead and opium wash. 
This treatment relieved him so much that he got a fairly good 
night's rest. The eserine seemed to keep the tension down some- 
what, tint as there was still some pain. 1 tapped the anterior cham- 
ber. using a cataract needle with a broad blade and a narrow shank, 
and the fluid which escaped was as black as ink. This operation was 
an immediate and permanent relief to the patient from all actual 
pain, but as the eye still remained sensitive and 1 was afraid of 
sympathetic ophthalmia. I advised enucleation. 
'Phis he dreaded and consequently kept putting it off. 
After a couple of weeks a small distinct hemorrhage, a little larger 
than a pinhead, appeared on the anterior surface of the lens. This 
was followed several weeks later by photophobia and lachrymation 
of the left eye, ami the patient then decided to have the offending 
organ removed. 
On October 7th. with the assistance of Dr. Arthur Breese, who 
administered ether. I enucleated the eye, and on the same evening, 
in the presence of Dr. Breese, I dissected it. 
The anterior chamber was filled with a fluid of the consistency 
and color of ordinary writing ink, the lens was cataractous, the cili- 
ary process hardened, tin* vitreous disintegrated and its chamber 
tilled with a thin bloody fluid. There was a small detachment of the 
retina just below the optic disc, and the disc was somewhat cupped, 
but what was of particular interest ami that which leads me to report 
the case, was a small black tumor, about the size of a duck-shot, on 
the outside of the siderotic coat about a quarter of an inch to the 
nasal side of the optic nerve; and on the inside of the eye, at a posi- 
tion corresponding to that of the tumor, was a small dimple, which 
gave the appearance of a portion of the retina and choroid having 
been pulled through a small opening in the sclera. Upon dissect- 
ing the tumor I found it to consist of a perfectly white substance 
surrounded by what seemed to be the sclerotic coat. I sent the speci- 
men to Dr. William May for microscopical examination, and he pro- 
nounced it a round celled sarcoma. 
In all probability it sprang from th 1 choroid, but, contrary to the 
usual rule, it had. for some inconceivable reason, taken the course of 
the greater resistance and grown outward, pushing with it the 
sclera, which enveloped it like an orange is enveloped by its skin. 
Whether or not this tumor was in any way associated with the 
intra-ocular hemorrhage, it is difficult to say. At all events, the 
case is one of the utmost interest, not only on account of its unsus- 
pected presence and the relative infrequency of this variety of neo- 
plasm, but more especially because it took the course of greater 
resistance, pushing the sclera before it. ami was not attended by 
any growth or bulging within the globe, a fact which is beyond com- 
prehension, and a similar instance of which 1 am unable to find in 
ophthalmologieal literature. 
The opportunities of examining such a growth in this location in 
an early stage of its development are rare, and I only regret that 1 
did not suspect its nature at the time I made the dissection and save 
the whole globe for future observation and study. 
It is fortunate for the patient that the removal of the eye has given 
him a better chance of escaping both local recurrence and metastatic 
deposits.