Several years have elapsed since Dr. R. Berlin described a series of cases in which he had observed a peculiar retinal change after the eye had been struck with a blunt object, as, for example, a stick or a stone. Under those circumstances he noticed a cloudiness of portions of the retina, not involving the retinal blood vessels. The milky appearance reached its height in twenty-four to thirty-six hours, and disappeared in two or three days. Berlin pointed out that the rapidity with which the cloudiness developed, and the length of time that it persisted, stood in direct relationship with the severity of the original injury. This curious condition, which Berlin calledcommotioretinæ, was associated with some reduction of sight, episcleral congestion, and a difficulty in getting the pupil to dilate when atropine was dropped into the eye. Small retinal hemorrhages were sometimes present. Berlin explained the ophthalmoscopic picture by supposing that a rupture of the choroid was followed by bleeding and œdema of the retina. This theory has recently been opposed by Denig. That observer, as the result of experiments upon rabbits, believes that the blow upon the eyeball causes the vitreous to impinge upon the retina, to tear the internal limiting membrane, and to force the vitreous into the nerve-fiber layer. The alternate elevations and depressions thus brought about in the nerve-fiber layer of the retina are, according to Denig, the cause of the ophthalmoscopic appearances.
Since the publication of Berlin’s original paper few cases ofcommotio retinæhave been recorded. Indeed, the retinal changes are of so fleeting a nature that an opportunity for observing them must occur comparatively seldom. This fact leads me to place upon record brief notes of a somewhat interesting case:
E. S., aged eleven years. First seen on July 25, 1899.
History.—At 6.45P. M., on July 24, the patient was struck in the right eye with a cricket ball, made of cork and covered with rag cloth.
Present State.—Right eye: Small abrasion of the skin of the lower lid, with a surrounding area of redness. Some general conjunctival congestion, with a definite ecchymosis in the ocular conjunctiva, opposite the lower-outer quadrant of the cornea. Tension minus 1. The pupil distinctly sluggish and a trifle larger than the other one. Anterior chamber deep. A narrow line of blood clot lay at the bottom of the anterior chamber. V.59(ii. letters). Pupil dilates imperfectly to a mydriatic. With the mirror alone some parts of the fundus oculi were seen to be unduly white. When examined more closely with the ophthalmoscope there was found a wide but defective zone of whitish fundus, situated peripherally upward, inward, and outward. No such appearances could be made out in the lower part of the fundus. The retinal vessels, which lay anterior to the affected areas, showed no changes. In most places it was possible to get beyond the whitish patches so as to see the edges of the latter. These margins were irregular, and showed white, tongue-like projections running into normal fundus. Some small islands of cloudiness lay, however, beyond the area of general haziness.Around the yellow-spot region was a white radiating appearance, but no definite white mass was present in that place. Left eye: No fundus changes. V.55(iv. letters). Tension normal.
Treatment.—Vaseline to abrasion of skin of lid; atropine drops (2 grs. to the ounce—to each eye twice a day); rest in bed.
Progress.—July 26. R. V.512; tension still rather low. The blood clot present in anterior chamber and also on anterior capsule of lens renders it difficult to see the fundus clearly; but no white patches can be made out in the fundus.
July 27. A little blood is still present in the lower part of the anterior chamber. The parts of the retina that were milky have resumed almost their natural appearance, and the changes above mentioned are now represented merely by a faint, whitish, ill-defined stippling of the areas in question. Around the yellow spot is a system of fine radiating lines, which extend for some distance into the surrounding fundus. This is doubtless due to œdema of the retina.
July 28. R. V.56(i letter); tension still slightlyminus. Ecchymosis present in ocular conjunctiva, but the blood has disappeared from the anterior chamber. Pupil not so wide as that of the left eye, although atropine is being used to both. Faint cloudiness lower third of the cornea, made up of almost transparent dots, as may be seen with a +20 lens in certain positions of the eye. Fundus changes have disappeared; faint radiating lines, however, may still be seen around the yellow-spot region.
July 29. R. V.56(ii letter) T—I. Pupil now as large as that of the other eye. Yellow-spot region still surrounded by a wide band of fine, closely set, radiating gray lines. It may be noted that the corresponding region of the left (unaffected) eye is encircled by an ordinary oval reflex.
August 1. R. V.56; (Tn.). A small ecchymosis still present in the ocular conjunctiva on the outer side of the cornea. No blood in anterior chamber; no corneal cloudiness. Radiating appearance still present around yellow spot of fundus.
August 9. R. V.59, L. V.59; (Tn.).
August 12. Vision unaltered. Radiating lines still present around yellow-spot region of affected eye.
September 5. The right pupil rather larger than its fellow, but no break in the continuity of the edge of the iris can be discovered to account for this. The action, both to light and to accommodation, of the pupils is equal. The radiating lines formerly present around the yellow spot of the right eye have been replaced by an ordinary oval reflex, like that present in the other fundus. Tn.; R. V.56(i letter), L. V.56(i letter); No. 1 Jaeger read easily.
September 7. Under atropine. R. V. =518+ 1.5 D. Sph. =55. L. V. =512+ 1.0 D. Sph. =55.
Deady.
Deady.
Deady.
Deady.