=Menzies, J. Acworth.—Detachment of Corneal Epithelium (?).=—_British
Med. Jour._, March 17, 1900.
The following case seems to be worthy of record because of the long
duration of the symptoms and the immediate relief ultimately obtained.
Mrs. W. consulted me on August 4, 1899, and gave the following history:
Five years previously the right eye was struck and “cut” by a cricket
ball. Since that time there had been pain exactly as if there was a
foreign body under the lid or embedded in the cornea. There was a
pricking feeling on winking, and the patient could not bear to have the
upper lid touched in its outer half. She could only obtain ease by
keeping the eyes closed and perfectly still, or wide open with the lids
motionless. On examination no foreign body could be seen, and the lids
were normal. In the lower outer quadrant of the cornea careful
observation showed that the epithelium was ruffled and freely movable
over a small area, and in part of the same area was a tiny circular,
slightly opaque, raised patch of the corneal tissue. Nothing more could
be made out. I prescribed a bandage and some boric lotion with cocaine.
Two months later, on October 6, I again saw the patient, who was then in
precisely the same condition as before, and had been so during the two
months’ interval. She was in such misery that I decided to adopt
surgical measures at once. Accordingly, after instilling cocaine, I
carefully explored the painful area with a needle, but could detect no
foreign body. I then scraped the part thoroughly with a sharp spoon,
removing the epithelium for some little distance around, and a fair
amount of corneal tissue in the affected area. The following day there
was some smarting, but the eye could be moved freely under the lid, and
there was no pain on pressure over the previously tender spot. Progress
was uninterrupted. The epithelium grew over the denuded surface, and no
opacity resulted. The eye now is perfectly right and the vision is
normal.
I should have put the difficulty I had in making a diagnosis down to my
having overlooked some detail, had it not been that the patient was for
a considerable time under treatment at an eye hospital. The explanation
I am inclined to adopt, for want of a better, is this, that the original
blow caused the anterior elastic lamina with the epithelium to become
detached. The nutrition of the epithelium might thus be kept up, and
every movement which pressed upon the surface would bring the detached
membrane down on the corneal nerve filaments. But it must be confessed
it is not easy to understand how this condition could remain stationary
for five years.