April 1918

The following is a rare case of innocent intra-orbital new growth having formidable effects upon the eyesight:—

Patient, a married woman, just suckling her fourth child, came under my notice in November, 1916. She then had prominence of the left eye for twelve years, but “the last seven months much more so.” This period coincided, in her opinion, with the bearing and suckling of her child. No pain in the eye, very little discomfort.

The condition then was: Left eye proptosed half an inch in front of level of the right eye, which is normal. The eyelid can completely cover the ball and the movements are not restricted. There is no perception or projection of light. There is no pulsation in the ball and it cannot be pushed back into orbit.

The ophthalmoscope shows a small patch of pigment on the upper inner side of the disc, the disc being very white. The veins dilated double normal. Arteries about as usual. The fundus was quite intact, there was no irregularity of surface of any kind such as would be shown by pressure of growth or invasion. The media were clear.

The diagnosis was, I thought, clear that it was not a malignant tumour, and as the patient had a large goitre and was suckling there was a possibility of the swelling going down if suckling and stress ceased.

The swelling did go down considerably.

In February, 1918, the patient came with the history that the last few months the eye had become very much more prominent.

On examination there was still no invasion of eyeball, no pulsation, no pain, but the swelling was twice as big as fifteen months previously and the patient thought that it had grown rapidly lately.

I advised removal of the whole eye and tumour and sent her down to Dr. Harty for an opinion. He was away, but Dr. Webster was kind enough to see her and had the orbit skiagraphed. It did not show very much, save that the orbital cavity appeared less distinct than usual. He thought the tumour non-malignant and advised removal as completely as possible.

Patient was admitted to hospital on her return and I removed the eyeball. A smooth, round, blue-grey walled cyst was exposed, about the size of a large walnut, unattached to the orbital wall save to the optic foramen. The lengthened optic nerve was intimately attached to one wall of the cyst, which contained pale yellow clear fluid.

The whole cyst was removed and sent to Professor Murray Drennan, whose report is attached. Recovery was uneventful.

Report by Professor Murray Drennan:— “The eyeball shows of little note. Cyst presents considerable difficulty. The optic nerve enters on one side and then is lost in the cyst. The wall of cyst consists of fibrous and granulation tissue, in parts of which are many vessels with thick hyaline walls. Many fat-laden cells are present in cyst wall and in optic nerve; also cells with blood pigment. The appearances suggest that a tumour, probably myxomatous, has been originally present on optic nerve. Haemorrhage into it has occurred with organisation, so that now only the latter appearances remain.”

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April 1918

The following is a rare case of innocent intra-orbital new growth having formidable effects upon the eyesight:—

Patient, a married woman, just suckling her fourth child, came under my notice in November, 1916. She then had prominence of the left eye for twelve years, but “the last seven months much more so.” This period coincided, in her opinion, with the bearing and suckling of her child. No pain in the eye, very little discomfort.

The condition then was: Left eye proptosed half an inch in front of level of the right eye, which is normal. The eyelid can completely cover the ball and the movements are not restricted. There is no perception or projection of light. There is no pulsation in the ball and it cannot be pushed back into orbit.

The ophthalmoscope shows a small patch of pigment on the upper inner side of the disc, the disc being very white. The veins dilated double normal. Arteries about as usual. The fundus was quite intact, there was no irregularity of surface of any kind such as would be shown by pressure of growth or invasion. The media were clear.

The diagnosis was, I thought, clear that it was not a malignant tumour, and as the patient had a large goitre and was suckling there was a possibility of the swelling going down if suckling and stress ceased.

The swelling did go down considerably.

In February, 1918, the patient came with the history that the last few months the eye had become very much more prominent.

On examination there was still no invasion of eyeball, no pulsation, no pain, but the swelling was twice as big as fifteen months previously and the patient thought that it had grown rapidly lately.

I advised removal of the whole eye and tumour and sent her down to Dr. Harty for an opinion. He was away, but Dr. Webster was kind enough to see her and had the orbit skiagraphed. It did not show very much, save that the orbital cavity appeared less distinct than usual. He thought the tumour non-malignant and advised removal as completely as possible.

Patient was admitted to hospital on her return and I removed the eyeball. A smooth, round, blue-grey walled cyst was exposed, about the size of a large walnut, unattached to the orbital wall save to the optic foramen. The lengthened optic nerve was intimately attached to one wall of the cyst, which contained pale yellow clear fluid.

The whole cyst was removed and sent to Professor Murray Drennan, whose report is attached. Recovery was uneventful.

Report by Professor Murray Drennan:— “The eyeball shows of little note. Cyst presents considerable difficulty. The optic nerve enters on one side and then is lost in the cyst. The wall of cyst consists of fibrous and granulation tissue, in parts of which are many vessels with thick hyaline walls. Many fat-laden cells are present in cyst wall and in optic nerve; also cells with blood pigment. The appearances suggest that a tumour, probably myxomatous, has been originally present on optic nerve. Haemorrhage into it has occurred with organisation, so that now only the latter appearances remain.”

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