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NOTES, CASES, INSTRUMENTS OPTOCHIN AMBLYOPIA
B. W. PASTERNACKI, M.D. DETROIT
On April 7, 1932, I was called to see a patient, a woman 32 years of age, who complained of partial blindness. Two weeks previously she had developed pneumonia and had been given twelve 2-grain tablets of optochin the day of onset. The next day, March 25, the same dosage of optochin was repeated. On the following day head-noises and poor hearing developed and within 60 hours after the first dose of optochin the patient was completely blind.
At examination the pupils were widely dilated, reacting feebly to strong light. The tension measured 32 mm. in each eye (McLean). The retinae were of a yellow straw-like color, the veins were hardly visible, the arteries were pale and the discs white. The condition no doubt was due to the optochin accompanied by retinitis septica and bilateral retrobulbar neuritis.
Twenty-one days after the onset of the illness she was delivered of a premature eight month baby and eight days later an operation for empyema was performed. Three pints of purulent fluid were drained from the pleural cavity after rib-resection. A week later a large rectal abscess was opened.
At this time the laboratory findings were as follows : sputum positive for pneumococcus; urine, albumen two plus, no sugar ; white blood cells 21,800 ; lymphocytes 2 percent, large mononu-clear cells 8 percent, neutrophilic cells 90 percent. The Wassermann was negative and blood pressure normal.
During the first week following April 7, eserine was used in each eye. Anti-pneumococcus serum was administered daily. From June 1 strychnine sulphate gr. 1/60 was injected in the temporal region changing sides on alternate days. These injections were reduced to two a week after June 20.
On August 26, she visited my office and could recognize and describe white metal furniture. Treatments of faradic
current from three dry cells were applied for three minutes to the forehead and around the eyes, especially to the supraorbital nerve. Also potassium iodide was given internally.
She left the city on September 25, at which time her vision was 5/35 in the right eye and 5/20 in the left eye. The near vision was Jaeger 10 at 34 cm. The visual fields were contracted and there were large paracentral scotomata. The retinal vessels appeared wider than at first, and the discs less white. On March 24, 1933, one year after the illness, the vision was 5/15 in each eye.
5765 Chene Street.
ATROPINE SOLUTION GIVEN BY MISTAKE ON PRESCRIPTION
FOR PILOCARPINE THOMAS D. ALLEN, M.D.
CHICAGO
Mrs. I. A., 44 years old, was first seen February 6, 1933, having an advanced case of noncongestive glaucoma in each eye. The pupils were 3.5 and 5 mm. in diameter, the anterior chambers slightly shallow, the corneae normal, and there was well-defined glaucoma-tous cupping 4 D. deep, with atrophy, pulsation of retinal arteries, and distinct glaucomatous halo. Tension was O.D. 60, O.S. 62 mm., Schiötz—new scale. There were only a small central field and a temporal island of vision in each eye. Eserine, pilocarpine and supra-renin bitartrate were used in succession and in various combinations for two weeks before the tension fell to 30 or below. After another two weeks because the tension rose to 48 mm. in the right eye, an iridencleisis was done, successfully.
The patient was sent home with a small left pupil and a prescription for 1-percent pilocarpine for that eye. Three days later the daughter telephoned that the patient was very dizzy and nauseated and she was brought back to the hospital. Here her left pupil was found widely dilated, tension + 3 , vision hand
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