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139 OPHTHALMOLOGICAL SOCIETY. minent and alarming character due to disease in other organs; but such cases are quite different from this one in that here there were found a large number of tumours scattered through both motor and sensory regions, evidently of very considerable age and yet apparently without causing symptoms till within a day or two of death, and even these symptoms were induced apparently by meningeal affection and not by the tumours. It is also I coteworthy that the child’s condition had all along been quite favourable for the observation of any cerebral symptoms that might have been present, and he was constantly under observation, so that their occurrence could scarcely have been missed. The mesenteric condition and the ulceration of the bowels were also of considerable interest ; but so many cases of a somewhat similar nature are met with that I do not desire to dwell upon this aspect of the case. They pro- bably constitute the primary lesion. Medical Societies. OPHTHALMOLOGICAL SOCIETY. Epithelial Pearl Twmo1t’1’ in the Iris following Implantation of Eyelash in the Anterior Chamber.-The Diagnosis and P1’ognosis of Pathological Myopia.-Reaurrent Third Nerve Palsy associated with Migraine. AN ordinary meeting of the above Society was held on May, July 7th, the President, Mr. HENRY POWER, M.B., 1.R.C.S., in the chair. Mr. F. RICHARDSON CROSS and Mr. E. TREACHER COLLINS contributed a paper on Epithelial Pearl Tumour in the Iris following Implantation of Eyelash in the Anterior Chamber. A boy aged eight presented himself for loss of sight in the right eye, seven months after the eye had been wounded with a piece of wire. On examination the eye was free from in- flammation, tension was normal and there was traumatic - eapsular cataract, with posterior synechise. At the upper inner segment of the anterior chamber was a small nodule, from which an eyelash passed downwards in front of the iris. An operation was undertaken to remove the eyelash and, if possible, the small nodule, which was diagnosed to be an epithelial implantation cyst growing from the root-sheath of ’the cilium. The eyelash was readily removed, but the cyst was so closely adherent to the iris, and this so fixed by adhesions that it could not be extracted, but came away piece- meal in the forceps. The wound healed well. Two months .afterwards the tumour had commenced to grow again. The patient then disappeared for nearly a year, when he returned with great irritability, lacrymation, and photophobia of the right eye. The tumour had much increased in size, and as the left eye was sympathetically irritated, and the former operation had been so difficult, the eye was enucleated and sent .to Mr. Treacher Collins, who reported the tumour to be sur- rounded by pigmented iris tissue, and free from the cornea, vitreous and ciliary body. The mass situated in the iris was a ’cyst with opaque white contents lined by laminated epithe- lium, the cells in contact with the iris tissue being the best developed, the innermost ones being flat and scaly ; the con- tents of the cavity consisted of fat globules and polyhedral wells in which no nucleus was stained. They were probably epithelial cells undergoing degeneration. The ,papillary border of the iris was united by newly formed fibrous tissue to the anterior capsule of the lens. Seven analogous cases were quoted as showing that the histology of the tumours was similar and that all have resulted from a long residence of an eyelash in the anterior chamber. In contradistinction the successful result of early removal of eyelashes from the anterior chamber was men- tioned and the immediate diagnosis of such a condition and its prompt treatment insisted on.-Dr. ROCKLIFFE (Hull) mentioned a case he had reported to the Society in which a cystic tumour in the anterior chamber had followed the im- plantation of an eyelash. Since reporting that case he had met with another in which one or perhaps two lashes had been carried into the anterior chamber by a piece of wire penetrating the cornea.-Mr. ERNEST CLARKE referred to a ’case he had reported two years ago, in which he had been able to remove the eyelash.-Mr. SNELL (Sheffield) spoke of case now under observation in which he had operated for cataract fourteen years since. There was now a cyst in the anterior chamber which he thought might be of the same nature as that described. Dr. RAYNBH D. BATTEN read a paper on the Diagnosis and Prognosis of l’athological Myopia. After reference to a former paper in which lie maintained that myopia was frequently the result of constitutional disease,l he said that the object of the present communication was to show that a diagnosis of the constitutional cause of myopia may be made from the condition of the fundus. Physiological myopia should be confined to a simply refractive con- dition, in which there is no fundus change of any kind. Physiological myopia is not necessarily a refractive con- dition, and may even be associated with emmetropia or hypermetropia, and is characterised by the formation of crescents, the stretching and distortion of the vessels, the presence of staphylomata, and by local and general dis- turbance of pigment. At present physiological myopia is not distinguished from pathological myopia in its early stages, but only when the latter is far advanced. Pathological myopia may be acute, chronic, progressive or stationary. The acute may end in arrest or become chronic, and may be the result of various constitutional diseases. In the chronic form a diagnosis may be made between myopia due to cardio- vascular conditions, struma and inherited syphilis and un- healthy occupations. Pigmentary changes associated with ’myopia: Marked pigment change at the margin of the cres- cent is a sign of acute myopia, and in the chronic form a distinction is made between a thin choroid, rendering the choroidal vessels visible and occasionally associated with a very fine dust-like retinal pigment change and a choroid in which the pigment appears to be divided into islands ; the former is attributable to cardio-vascular conditions; the latter, to strumous or specific disease. f3taphylomata: Four classes : (1) That in which the staphyloma is in the macular region ; i (2) that in which it occurs on the nasal side; (3) that in which the optic dbc forms the deepest part of the staphyloma; and (4) that in which it takes place towards the periphery. In all cases except the first the refractive condition at the optical axis is no measure of the extent of the myopia. Peripheral myopia is a cause of astigmatism, by causing distortion of the lens and cornea. Distortion of the vessels : Three forms : (1) When the vessels are drawn from their normal course in relation to the optic disc ; (2) when they appear stretched and straightened ; (3) when they emerge by separate branches from the optic disc. The direction of the distortion of the vessels depends on the posi- tion of the staphyloma. This is particularly marked in cases of nasal staphyloma, the vessels being drawn to the nasal side of the optic disc and the macular branches having to bend back in order to supply that region. Distortion of the vessels is one of the early signs of commencing myopia. The direction of the distortion points to the position of the staphyloma and the degree of the distortion or stretching of the vessels is an important factor in the prognosis. Central (physiological) cupping of the optic discs is a form of the staphyloma and an early manifestation of commencing myopia and responsible for the exit of the vessels from the optic disc in numerous branches, the main trunk of the vessels having been drawn into the staphyloma. The early premonitory signs of myopia are central cupping, distortion of the vessels, commencing crescents and astigmatism. Mr. SNELL (Sheffield) related two cases of Recurrent Third Nerve Palsy associated with Migraine. One was in a young man aged twenty-seven. Migraine had existed since the age of ten, but only for the last seven years had the eye been closed with the attacks. The attacks occurred at first at in- tervals of about eight weeks, then at every two or three weeks, and lasted for three or four days. The palsy of the third nerve was practically complete ; ptosis and paralysis of the ocular muscles, together with dilated pupil and palsy of accommoda- tion. The attacks commenced with vomiting and headache. The ocular palsy in the interval did not completely pass off, and the latest accounts, two years after he had last been seen, indicated that the drooping of the lid was becoming more permanent. The second case was in a girl aged eighteen. She had two attacks at intervals of four years, though migraine outbreaks continued in the interval. Each time she had made a perfect recovery, though the third nerve was not, at the worst, as completely involved as in the first case. Recovery was much longer in taking place. Mr. Snell gave additional particulars of a similar case he had brought to the notice of the Society some years ago. He remarked 1 Ophthalmic Review, January, 1892.
