=Stephenson, Sydney.—Concussion of the Retina.=—_Brit. Med. Jour.,
January, 1900._
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 called _commotio
retinæ_, 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 of _commotio
retinæ_ have 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 6.45 P. 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. 5/9 (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. 5/5 (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. 5/12; 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. 5/6 (i letter); tension still slightly _minus_.
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. 5/6 (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. 5/6; (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. 5/9, L. V. 5/9; (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. 5/6 (i letter), L. V. 5/6 (i
letter); No. 1 Jaeger read easily.
September 7. Under atropine. R. V. = 5/18 + 1.5 D. Sph. = 5/5. L. V. =
5/12 + 1.0 D. Sph. = 5/5.