174 W. H. LUEDDE

diagnosis of ocular tuberculosis highly probable, but does not make it absolutely positive.

2. The therapeutic benefits obtained from the use of tuberculin in ocular tu­berculosis must be recognized but can be explained rationally either as a spe­cific or a nonspecific effect.

3. Clinical experience demonstrates that the radical elimination of focal in­fections especially those of the naso­pharynx and the proper treatment of any coexisting constitutional disease will render less and less frequent the indica­tions for the use of tuberculin, either as a diagnostic or therapeutic agent in ophthalmic practice.

4. Further research is needed to dis­cover the unknown factors concerned in resistance to tuberculous disease. Thus the treatment of tuberculosis may be placed on a definite scientific basis which

The case here reported is that of Joseph O'Neil, nine years old. In 1908, the patient was treated in the ophthal­mic department of the University of Pennsylvania, as well as in St. Mary's Hospital, where he applied for eye treatment, giving the following his­tory:

Measles at 3 years of age, since which time the eyes have been in­flamed more or less constantly.

The right eye showed an opaque band extending across the lower third of the cornea. Numerous dot like opac­ities, varying in size and density from pinpoint to pinhead, and in color from gray to a chalky' white, were present, and were denser and more numerous toward the nasal side. To the outer side the cornea is hazy, and the pupillary space was found to be covered by chalky de­posits. V.=20/50.

it can hardly be said to possess at the present time.

On account of the facility for the ac­curate observation of minute changes in ocular lesions by the aid of microscopy of the living tissues made possible with the slit lamp, corneal microscope, and Gullstrand ophthalmoscope, ocular tuber­culosis may offer a most fertile field for future research.

It is a privilege to acknowledge the receipt of so much help from so many interested observers, both inside and out­side of the group of ophthalmic special­ists, in the collection of the material for this report. The writer hereby expresses his thanks to each and every one of them and especially to Dr. M. S. Fleischer, Dept. of Pathology, St. Louis University School of Medicine, for his active coop­eration in the preparation of the ques­tionnaire and classification of replies.

The left eye showed opacities that oc­cupied a central position in the cornea; they were circular in outline. The pupil­lary space is also covered by deposits. V. O. S—3/100.

A number of the cervical glands were enlarged, but no scars were found. The laboratory reports were inconclusive, and gave a tentative diagnosis of rickets. Night sweats were present. At that time the clinical diagnosis was uncertain, and rested between keratitis dendritica or the well known band shaped keratitis, or ulcerative keratitis.

In 1916 the patient returned to St. Mary's for glasses. On examination, numerous deposits of cholesterin crystals or lime salts were found distributed over both corneae, including also the pupillary areas. Vision before operation: O.D. =20 /70 ; with correction 20/30??; OS. =15/CC,

CORNEAL DEPOSITS OF CHOLESTERIN AND LIME SALTS DISSOLVED BY ALCOHOL.

Louis F. LOVE, M.D.

PHILADELPHIA.

Many attempts have been made to remove corneal opacities by dissolving them by local applications. This paper records a striking and rapidly successful effort in this direction and the method appears to be safe. Read before the American Academy of Ophthalmology and Oto-Laryngology, September, 1922.

CORNEAL DEPOSITS DISSOLVED BY ALCOHOL 175

Ophthalmoscopic examination of the right eye showed the cornea to be macu­lated, with numerous deposits of chol-esterin or lime salts distributed thruout the structure. No gross pathologic changes in the eyeground were found.

The cornea of the left eye was in prac­tically the same condition as that of the right. In this eyeground, however, to the temporal side, a large patch of cho-roidal atrophy was discernible, with evi­dences of absorption, surrounded by pigment extending to the macular region. The Wassermann test was negative, as was also the urinary examination. Tubercular tests were not satisfactory.

The patient was admitted to St. Mary's Hospital for operation. The right eye was operated on first. The epithelium of the cornea, Bowman's membrane, and the deeper tissues which covered the cholesterin deposits were picked off with a discission needle. A 95 per cent solu­tion of alcohol was applied. This im­mediately dissolved the lime, which infil­trated the cornea and spread over the surface, making the entire cornea milky white in color. This was somewhat alarming, and gave rise to the fear that irreparable damage might have been in­flicted on the eye. On the following day, however, the solution had entirely absorbed, and the cornea was clear and bright. After a few days the left eye was operated on with similar results. The vision improved; O.D., 20/70, with 3D.CO.75 D. ax 165 gave 20/20??; O.S.—15/200 with S. 3.50 D.=20/100.

A careful search thru the literature has failed to disclose the reports of cases similar to the one here described, in which the treatment of cholesterin de­posits by alcohol solution was employed. In Wood's Ophthalmic Therapeutics, page 394, Bimbacker recommends for the removal of calcareous deposits in the cornea, that the chalky infiltration be touched with a 5 per cent solution of hydrochloric acid, which should at once be neutralized by sodium carbonat of similar strength.

In Noyes' Diseases of the Eye, page 382, the following statement is made:

"The calcareous deposit occurs beneath the epithelium in irregular specks and lines, and slowly increases during years. It gives rise to no irritation until it at­tains considerable size and causes ero­sion of the epithelium; it then acts as a foreign body, and should be scraped away under the influence of cocain."

In Norris and Oliver, Textbook of Ophthalmology, page 346, it is stated that Bowman, Dixon, Nettleship, and other English writers have had good results, and have improved the eyesight by cut­ting and scraping away the calcareous deposits. In some of these instances the good results have been permanent, and have not been followed by an increase of intraocular tension.

J. P. Nuel, of the University of Liege, Belgium, writing in Norris and Oliver's System of Diseases of the Eye, vol. iv, p. 243, states: "Special mention should be made of a rather frequent corneal disease which was described by von Graefe under the title of 'Bandular Keratitis.' On a plane with the palpe-bral slit, a grayish or somewhat yellow­ish, nonvascularized inflammation ap­pears, which extends transversely across the cornea; its surface is finely granular or rough, like granite, and rather dry. As for treatment, nothing can be hoped for a clearing up of the macula. If the eye be not amaurotic, scraping of the cornea may be beneficial, as the reformed tissue is ordinarily more transparent than the macula."

In conclusion I feel quite sure that alcohol in these cases is a valuable remedy, but what impressed me more than anything else was that our knowl­edge at the present time as to the' chemicophysiologic or pharmacologic action of drugs on the human eye is ex­tremely meager. It seems to me that more experiments and investigations should be made, so as to enlarge our phy­siologic therapeutics. In other words, less study perhaps of pathology of the dead eye and more of the physiology of the living eye.