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that he had lost some vision in the right eye two years previously following a cold. Two weeks ago he had noticed that the vision of the right eye was even worse, and that the left eye was also affected. There had been no pain or redness in the eye at any time.

On examination one found both eyes quiet. The. vitreous in each eye con­tained many fine floaters ; the right also containing a large, long floater. The disc edges seemed slightly indistinct, but there was no cupping, elevation, atrophy, or hyperemia. The vessels were somewhat contracted and there was one small area of old chorioretini-tis, up and nasally, from the disc in the right eye. Each macula appeared some­what degenerated. The vision O.D. was handmovements, and O.S. was 4/15 with —0.50 D. sph. The pupils reacted well to light and accommodation.

The field of the right eye showed a marked defect, up and to the left, both quantitatively and with colors ; this up­per left defect was also present in a less striking degree in the field of the left eye. Roentgenograms showed slight density of the antra and ethmoids of each side. The frontal and sphenoidal sinuses were clear. There was a bony closure of the anterior and posterior clinoid processes. The spinal fluid was under normal pressure, cell count 2.5, and Wassermann and colloidal gold were negative. The spinal fluid protein, however, was 62 mg. per 100 cc. (30 was normal). Dr. J. R. Jaeger had sug­gested arachnoiditis at the optic chiasm, as a diagnosis, but believed the eth­moids and sphenoids should be further investigated.

The case was presented because of the indefinite diagnosis and the ques­tion as to whether the abnormalities of the eyes themselves were enough to ac­count for the degree of loss of vision.

Discussion. Dr. W. C. Finnoff thought the abnormal vitreous and f un-di might possibly account for the low­ered vision, but not the field changes.

Dr. G. H. Stine mentioned that the urinary proteose might be used in treat­ment if no other cause was found.

Dr. D. H. O'Rourke said that in view of the history of several miscarriages by

the patient's wife, he would certainly consider syphilis. It was his custom in serious cases to send the spinal fluid to two different laboratories. He had seen one case of uveitis apparently very satisfactorily treated with urinary pro­teose.

Pterygium with imbedded cilia Dr. E. R. Neeper reported the case

of Mrs. S., aged sixty-seven years. One cilium in its entirety lay beneath the body of the pterygium from its apex downward, largely in a line from "1 o'clock to 7 o'clock." The other two cilia were transverse, the temporal one-half of each being free and lying on the bare cornea, while the nasal half of each punctured and extended into the body of the pterygium.

R. W. Danielson, Secretary.

MEMPHIS SOCIETY OF OPHTHALMOLOGY AND

OTOLARYNGOLOGY January 10, 1933

Dr. J. B. Stanford presiding Primary optic atrophy

Dr. A. C. Lewis reported on B. B. McK., aged twenty-four years, who when one and one-half years old was given doses of quinine for "congestive chills." Complete blindness immediate­ly appeared and remained for nearly four months. He was finally able to read fine print and to graduate from High School, but the fields had remained contracted and acuity of vision reduced.

In February, 1931, he had an attack of "flu" with only slight evidence of nasal or sinus infection and no cough but he suffered general soreness and tenderness and could not be moved in bed without great pain. Vision became very poor but later improved somewhat.

On October 1, 1932, the pupils re­acted slightly to light and accommoda­tion and tension was normal. The vision in the right eye was finger count­ing at ten feet ; the field was contracted to a six inch circle at a distance of one foot. The left eye had light perception.

444 SOCIETY PROCEEDINGS

The optic discs were atrophie, the retinal vessels threadlike.

The general medical and neurologi­cal examinations were negative. Exten­sive laboratory and x-ray studies were also negative except for cloudiness of the nasal sinuses and soreness of the eyeballs upon movement. The tonsils were hypertrophie.

Because of the seriousness of the case from the visual standpoint it was felt advisable to perform an operation on the sinuses and remove the tonsils. This was done in two stages. Sufficient time for improvement had not elapsed.

Discussion. Dr. J. B. Stanford ob­tained some additional history from the patient. He thought the patient had an idiosyncracy for quinine. It was his opinion that most operations on the sinuses advised for optic nerve lesions were unnecessary and unsuccessful.

Dr. A. C. Lewis stated that nothing definite in the sinuses had been found ; the boy was desperate and wanted something done. The operation could do no harm and might do some good. His vision as a child was never as good as other children and quinine idiosyn­cracy was the probable cause.

Total ophthalmoplegia Dr. John Nicholson (by invitation)

presented the case of Mrs. J. B., thirty-five years old, married and colored. She had had two children and no miscar­riages. The patient stated that two weeks before the onset of her eye symp­toms, she developed pain and throbbing in her left ear. This was relieved when the ear started to discharge. At about this time she noticed pain around and above her left eye associated with fron­tal headaches and dizziness. She gave no history of diplopia. This condition lasted for about a week when the pa­tient noticed a drooping of her upper lid and bulging of· the left eye. Four weeks later, the patient was admitted to this clinic. On admission her vision was impaired. Physical examination showed marked ptosis and exophthal-mos, a fixed, dilated pupil with paraly­sis of accommodation. There were no inflammatory signs. When the eyeball was pushed slightly it receded into the

orbit. All muscular movements were absent with the exception of a slight downward torsion. The media were clear, the disc and fundus were nega­tive. Teeth were carious and tonsils chronically inflamed. The Kahn test was negative. On the basis of this data a diagnosis of total ophthalmoplegia of unknown etiology was made. The pa­tient was given mixed treatment for about three weeks and at present her eyelid had already recovered a portion of its function.

Discussion. Dr. A. C. Lewis had oper­ated on a patient last May for conver­gent strabismus, doing a muscle resec­tion. The recovery was uneventful but after three weeks there was a complete ptosis and ophthalmoplegia of the un-operated eye. All muscles but the su­perior oblique were involved. Nothing could be found as a cause except two bad teeth which were extracted, but mixed treatment was given with com­plete recovery.

Dr. J. B. Stanford thought that the ear infection did not cause the eye con­dition and that the Kahn test was near­ly always negative in neurosyphilis.

Dr. Nicholson said that there had been three or four similar cases recent­ly, all with positive Kahn reactions.

Choroid tigré Dr. J. B. Stanford presented Mr. J. B.,

eighteen years old, who gave a history of always having had poor vision. His vision in the right eye was 1/200 and in the left eye 2/200. The maculae and areas surrounding them showed a "tiger-striped" pigmentation of the choroid. These pigmented stripes prob­ably followed the choroidal vessels and might be the result of choroidal hemor­rhages. The refractive error did not ac­count for the poor vision. General phys­ical examination was negative.

Glaucoma simplex Dr. A. C. Lewis presented Mrs. M. R.,

aged fifty-two years, who was seen for treatment on November 14, 1932, with a history of failing vision for two years, much worse in the past three months.

On this date the vision in O.D. was 20/150, O.S. light perception only; no

SOCIETY PROCEEDINGS 445

headaches, pain, or soreness in the eyes. The anterior chambers were very shal­low and pupils moderately dilated. Ten­sion O.D. was 45 mm., O.S. 95 mm. (McLean). There was nothing in the general health to account for the glau­coma.

A scierai trephining was performed on each eye November 15th. Little fil­tration was obtained. Eserin and dionin were used but the tension remained high. The right eye, which had been the better eye, became congested and pain­ful and the vision very poor.

On December 10th, the tension was 90 mm. in each eye. Four instillations of glaucosan at 15 minute intervals re­duced this to 80 mm. Very violent head

pains developed, requiring morphia. Two days later the tension was 70 mm. in each eye, to rise again. Deep iridec-tomies were then made, avoiding the trephine openings. Magnesium sulphate one-half ounce daily has been given to date. Urinalysis showed two plus al­bumen and many pus cells so urotropin had been administered for two weeks.

On January 9, 1933, the patient had made a general improvement. The ten­sion in O.D. was now 27 mm. and O.S. 34 mm. The vision in O.D. was 5/100 and improving. There was no improve­ment in vision of left eye.

Ralph O. Rychener, Secretary.