A case of unilateral annular scleritis / by D. B. St. John Roosa ; with a report of the pathological examination by Edward L. Oatman.

  • Roosa, D. B. St. John (Daniel Bennett St. John), 1838-1908.
Date:
[1905]
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Credit: A case of unilateral annular scleritis / by D. B. St. John Roosa ; with a report of the pathological examination by Edward L. Oatman. 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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    to the ligantentum pectinatum irides. The iritis being of a low grade, the peripheral adhesions readily yielded to the back- ward drag of the ciliary body and iris. This displacement of the iris and ciliary body cannot be attributed to the usual cause, namely, the organization and shrinking of inflammatory exudates. The only apparent explanation is pressure in the anterior chamber from the large transudate resulting from an obstructed anterior ciliary circulation. Another remarkable feature is a large deposi,t in the tendon of the external rectus muscle. At its point of attachment to the globe, the tendon, tendon sheaths and surrounding sclera are largely replaced by the characteristic deposits (Fig. 8). Small scanty deposits are found at the junction of the extemus with its tendon. They are strictly confined to the interstitial connective tissue, the muscle fibers not being affected. The sheaths and surrounding tissues are greatly distended with a serous effusion. The protuberance thus formed in con- nection with an underlying ectasis of the sclera, constituted the staphyloma observed clinically. At this point is a complete rupture of the sclera, extending from the anterior margin of the tendon of the extemus, backwards and inwards to the interior of the eye. Along the line of rupture the scleral fibers show marked degenerative changes, while their interspaces con- tain coagulated fluid, free pigment and pigmented cells. This communication between the interior of the eye and the external protuberance explains the sudden appearance of extreme flacidity observed in both, as is described in the clinical history. The low tension cannot be attributed to phthisis bulbi or lack of aqueous, the ciliary body being only slightly atrophic. This fistulous opening was probably produced by the following con- ditions: high intraocular pressure; extensive destruction, weak- ening and ectasis of the sclera; continuous drag of the external rectus muscle on its diseased tendinous attachment; violent blow on the eye and temple. It cannot be asserted that new connective tissue has formed from the cellular deposits, yet the changes in the periphery of the densest areas indicate that such a process has commenced. It is probable that our case exhibits an early stage of scleritis, the unique occurrence of a fistulous opening leading to early enucleation.