=Lawson, Arnold.—Cicatrix Horn Growing from the Cornea.=—_The Lancet_,
February 3, 1900.
The patient was a female child, aged eight years, a hydrocephalic idiot.
The history given was that about one year previously a white spot had
appeared on the right eye and that the eye began to project. Six months
later a growth was first noticed on the right cornea, and this had
constantly increased in size. Latterly a white spot had appeared on the
left eye. On examination of the eyes there was seen a large conical
tuberculated excrescence protruding between the lids of the right eye.
It was half an inch in length and its base attached to the cornea
covered about four-fifths of its surface. The left cornea exhibited a
yellowish infiltration just below the pupil, over which the cornea was
bulging; the anterior chamber was deep, the iris was immobile, the
tension was slightly raised, and the eye was quite blind. Both globes
were very anæsthetic, and there was considerable muco-purulent discharge
from a chronic inflammation of both conjunctival sacs. The growth upon
the right eye was accidentally detached a few days after admission into
the hospital, and it was then seen to have been attached to the cornea
at the apex of a central staphyloma, which was left covered by a fleshy
soft core which had formerly been embodied in the center of the growth.
The cornea was entirely opaque, and the eye was quite blind. After
removal of the right eye a few days later examination of the globe
revealed a co-arct retina with evidences of chronic degenerative changes
in all the various structures. The anterior chamber was completely
abolished, the iris throughout its extent being firmly adherent to the
back of the cornea, which was bulging centrally. The apex of the corneal
staphyloma had evidently been the site of a large perforation, which was
closed by the fleshy granulations which formed the core of the growth.
The growth itself measured half an inch from apex to base and one and a
half inch around its base.
The interior portion was soft and crumbling, but the external layers
were hard and horny and cut with difficulty. A wedge-shaped piece was
cut away from the growth and specimens were cut and stained with
carmine. The microscope showed that the external layers consisted of
several faintly fibrillated strata of a dense, homogeneous nature. The
layers occupied about one-quarter of the entire thickness of the walls,
the rest being entirely composed of small nucleated cells, those most
external being stratified. Adopting Mr. Bland Sutton’s classification of
human horns, this growth would be an example of a cicatrix horn, the
rarest of all varieties of horn, and one which had been usually found in
connection with cicatrices of burns and scalds. The probable ætiology in
this case was an overgrowth of granulation tissue closing the
perforation in the cornea, which, owing to an unhealthy condition of the
wound and eye, which was anæsthetic and atrophic, had become exuberant,
simulating exactly the condition known as “proud flesh” elsewhere. By a
process of accumulation and heaping up, the granulations gradually
formed a cap over the cornea, whilst the external layers gradually
became stratified and horny from the pressure of fresh growth from the
central core and by the action of the air. The nature of the growth was
evidence that the corneal epithelium bore no share in its production and
discounted the possibility that it might be due to a huge crust of
inspissated conjunctival discharges.