Orbitalphlegmone und Sehnervenatrophie / von J. Öller.

  • Öller, J.
Date:
1901
Catalogue details

Licence: In copyright

Credit: Orbitalphlegmone und Sehnervenatrophie / von J. Öller. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    The patient I now exhibit to you, whom some of you have seen before, fiirnishes us with an excellent example of frontal sinus era- pyema, and in giving you a bistory of bis case, and in drawing your attention to tbe Operations tbat have been performed for the relief of the Symptoms, you will have a clearer idea of the usual procedures in empyema than if I were to speak without Illustration. C. L., aged forty-seven, was referred to me by Dr. E. A. Doepp, of Blue Island, Illinois, on aecount of a discharge from tbe orbital region. Tbe patient lost his right eye, twenty-five years before, from an injury, and the globe is now shrunken. He is a well-nourished, muscular man, and a careful examination of his internal organs does not disclose any organic disease. Six months ago he began to have very severe, left, supraorbital pains that radiated over the corres- ponding temple and occasionally affected the right side. These were continuous most of the time for four months, and affected the pa- tient's general health. After they had lasted for about three months, he noticed a swelling above and to the inner side of the left eyeball, and with the appearance of this tumor came a diminution in the severity of the headaches. They now appeared only at irregulär interv'als. The swelling was so great that it displaced the globe and seriously interfered with the ocular excursions. Shortly afterwards an abscess pointed almost directly above the eyeball, and finally dis- cbarged externally, foUowed by temporary, but complete and im- mediate, relief of the supra-orbital discomfort. The present condition of the left eye is as follows: One notices, first of all, considerable prominence of the supra-orbital ridge; there is marked oedema of the palpebral skin and some infection of the conjunctivse; the upper lid, towards the inner canthus, is slightly red and glazed; the patient cannot raise his upper lid to its füll extent; there is a depressed opening in the skin, midway between the pupil and lower edge of the eyebrow, almost corresponding to the supra-orbital notch, from which a small quantity of creamy- white pus can be squeezed on making deep pressure at any point in the orbit near its upper margin, while a round, firm tumor can be feit beneath it. On passing a probe through the fistulous opening, it easily penetrates about twenty-five millimetres in an upward-in- ward direction to the roof of tbe orbit. The fistulous abscess has been treated for a couple of months by many methods (cleansing injections of bichloride, boric acid, iodine,