OF

CASE

ANEURISM

OF

ORBIT.

Prichard, M.R.C.S., Surgeon

A. W..

By

to the Bristol

Royal

Infirmary. wish to record very briefly a case of traumatic aneurism of the orbit, treated eventually by ligation of the I

common

but not

carotid,

wholly,

in which the treatment has been

partly,

successful.

James Sparks, set. 10, was looking through a keyhole on the 23rd of May, when a boy at the other side of the door pushed a piece of umbrella-wire through the keyhole into his eye. The wire, probably, was thrust deep into the orbit by the inner side of the eyeball. He A was taken to the Infirmary at once, and detained. small wound on the conjunctiva, and some blood under it towards the inner side, were the most noticeable signs of the

injury.

A few hours afterwards there

able

the

the

was

of the

injured

eye

was

consider-

almost fixed, moving from inch; this, of course, was

globe ecchymosis; only about ^ of an cause of double vision, and, excepting that,

side to side

was

unaffected.

the

sight

268

ANEURISM

OF ORBIT.

During the first fortnight the ecchymosis was the only symptom?both lids were very dark, and the ocular conjunctiva had blood under it. The boy complained very little, and a cold pad was kept generally over the eye. By June 9th, however, I noticed that there was some protrusion, and a faint pulsation could be felt on putting the hand over the eyeball. On listening with a stethoscope on the eye, a loud bruit could be heard; this was audible all over that side, and faintly over the other side of the Moreover the boy complained of a blowing cranium. sound in the left

Thinking

possibly

of

a

ear.

the

case was one

blood-tumour

of traumatic aneurism?or

pressing on

the carotid

artery,

for three weeks I tried the effect of continuous pressure on the eyeball and ice around the orbit. This had the effect of

ameliorating the diplopia?but accurate measurement from the forehead proved that the protrusion of the globe was increasing. By July 4th the protrusion had increased so that the injured eye was as much as -j-g- of an inch in front of the

other.

There

was

all round the

considerable chemosis, and blueness

marked, it; and stopped entirely

the bruit

orbit;

was

pressure on the left carotid boy had headaches and restless after

consultation,

carotid I had

large,

great

and

be held

July 5th.

as

it

difficulty were

carefully

in the

enveloping

but did the

In the heard and

evening no

and the

nights. Accordingly, ligatured the common

operation?the

cartilage. vein

was

the artery, and it had to I tied the vessel with

out of the way.

medium-sized catgut, and put

wound,

I

that side at the level of the cricoid

on no

on

very

a

small drainage tube in the

operation

without

after the

operation eyeball

pulsation felt,

a

spray. bruit could be

no

and the

had receded

269

TREATMENT OF WARTS.

of

an

inch.

During

the. next week the

went on

boy

very well. The wound healed kindly and the eye receded, the double vision was less, and the chemosis and swelling of tissues round the orbit went down. him in the

after, and bruit, which disappointed as was heard early as one week after the operation?however, it was not nearly so loud, and the boy could not I

was

kept

hear it himself. had

come

still

He is

The

forward,

protrusion only was

Infirmary

eyeball

now

receded

and when the of

amounted to

present?otherwise

is red and

for six weeks

at the return of the

much

much in the

the

same

prominent?there

as

patient an

boy

was

bruit,

as

it

went out the

inch: the

condition

is still a

gradually

diplopia

well. as

but

then?his eye no

pulsation.