PULSATING EXOPUTIIALMOS, attended with a distinct bruit heard over the temple and neighboring parts and audi ble to the patient, is most frequently caused by a rupture of the carotid artery into the cavernous sinus. This may occur spontaneously or from crushing injuries to the head. Pulsating exoph thalmos has sometimes ended in spon taneous recovery. In other cases no lesion was revealed by post-mortem dis section. In a few cases it has been due to aneurism of the ophthalmic artery.
Treatment.—Pressure on the carotids, either intermittent, which may be made by the patient himself, or continuous, should be tried. When pressure fails, ligation of one, and often the second, carotid should be resorted to.
Case of traumatic pulsating exophthal mos, most probably caused by orbital aneurism, successfully treated by em ploying compression of the correspond ing external carotid and medication. Hirschberg (Dent. med. Woch., No. 15, '89).
Plea made for early ligature in cases of pulsating exophthalmos. Walker (Lancet, Jan. 27, '94).
Orbital Cellulitis.
General inflammation of the extra ocular contents of the orbit arises from traumatism, cold, erysipelas, other spe cific fevers, metastasis in septicaemia, thrombosis of the cavernous sinus, or ex tension of inflammation from the eye ball, or from the walls of the orbit, or the neighboring cavities.
Symptoms. — There is pain in the orbit, and often severe general headache, lessened mobility of the eyeball, protru sion of the eye, and swelling of the orbital tissues and lids. The vision is impaired and diplopia may be noticed.
The invasion may be marked by a severe chill, and considerable fever may attend the disease. The eyeball is liable to come involved in the inflammation; and, even if this does not occur, optic neu ritis and atrophy are apt to result. There is serious danger of extension to the meninges of the brain, causing death.
In a few cases the symptoms are mild and spontaneous recovery occurs in a few clays.
Case of acute necrotic cellulitis of both orbits, with absence of any discoverable cause. There first formed an abscess be hind the globe, from which an ounce of pus containing fragments of necrotic tis sue was evacuated. Soon the entire con tents of the orbit became involved in the necrotic process. Subsequently the other orbit became involved, and eventu ally the patient succumbed from pynmia. W. T. H. Spicer and H. Wilbe (Lancet, Nov. 5, TS).
Treatment.—On the appearance of the earliest symptoms free local bleeding by leeching, or the artificial leech, should be resorted to, and calomel given and followed by a saline purgative. Hot fomentations should be applied, and fre quently renewed to keep them as hot as can be borne. Any localized tion of pus should be promptly and freely evacuated. Even when no pus has accumulated, it is well to make in cisions with a straight bistoury, from the retrotarsal folds of the conjunctiva, parallel with the orbital walls and as near them as possible, to the depth of an inch or more. These incisions may be washed out with warm, anti septic solutions and packed with anti septic gauze. When swelling of the lids prevents the making of such in cisions from the conjunctival sac, they may be made through the lids, near the orbital margin. In any case they should be so placed as to avoid injury to the ocular muscles if possible. If the eye ball has been the starting-point of the orbital inflammation, and is so damaged as to preclude vision, it should be promptly enucleated. The general treat ment should often include tincture of iron, quinine, and good feeding, and sometimes alcoholic stimulants.
For eellulitis, the skin of the orbit should be repeatedly painted with a 5 per-cent. solution of silver nitrate, and a boric-acid dressing and roller pressure bandage applied. Godfrey (Med. Rec., Nov. 3, '94).