Several years have elapsed since Dr. R. Berlin described a series of cases in which he had observed a peculiar retinal change after the eye had been struck with a blunt object, as, for example, a stick or a stone. Under those circumstances he noticed a cloudiness of portions of the retina, not involving the retinal blood vessels. The milky appearance reached its height in twenty-four to thirty-six hours, and disappeared in two or three days. Berlin pointed out that the rapidity with which the cloudiness developed, and the length of time that it persisted, stood in direct relationship with the severity of the original injury. This curious condition, which Berlin called commotio retinæ, was associated with some reduction of sight, episcleral congestion, and a difficulty in getting the pupil to dilate when atropine was dropped into the eye. Small retinal hemorrhages were sometimes present. Berlin explained the ophthalmoscopic picture by supposing that a rupture of the choroid was followed by bleeding and œdema of the retina. This theory has recently been opposed by Denig. That observer, as the result of experiments upon rabbits, believes that the blow upon the eyeball causes the vitreous to impinge upon the retina, to tear the internal limiting membrane, and to force the vitreous into the nerve-fiber layer. The alternate elevations and depressions thus brought about in the nerve-fiber layer of the retina are, according to Denig, the cause of the ophthalmoscopic appearances.
Since the publication of Berlin’s original paper few cases of commotio retinæ have been recorded. Indeed, the retinal changes are of so fleeting a nature that an opportunity for observing them must occur comparatively seldom. This fact leads me to place upon record brief notes of a somewhat interesting case:
E. S., aged eleven years. First seen on July 25, 1899.
History.—At 6.45 P. M., on July 24, the patient was struck in the right eye with a cricket ball, made of cork and covered with rag cloth.
Present State.—Right eye: Small abrasion of the skin of the
lower lid, with a surrounding area of redness. Some general
conjunctival congestion, with a definite ecchymosis in the ocular
conjunctiva, opposite the lower-outer quadrant of the cornea.
Tension minus 1. The pupil distinctly sluggish and a trifle larger
than the other one. Anterior chamber deep. A narrow line of
blood clot lay at the bottom of the anterior chamber. V. 5
9 (ii.
letters). Pupil dilates imperfectly to a mydriatic. With the
mirror alone some parts of the fundus oculi were seen to be
unduly white. When examined more closely with the ophthalmoscope
there was found a wide but defective zone of whitish
fundus, situated peripherally upward, inward, and outward. No
such appearances could be made out in the lower part of the
fundus. The retinal vessels, which lay anterior to the affected
areas, showed no changes. In most places it was possible to get
beyond the whitish patches so as to see the edges of the latter.
These margins were irregular, and showed white, tongue-like projections
running into normal fundus. Some small islands of
cloudiness lay, however, beyond the area of general haziness.
Around the yellow-spot region was a white radiating appearance,
but no definite white mass was present in that place. Left eye:
No fundus changes. V. 5
5 (iv. letters). Tension normal.
Treatment.—Vaseline to abrasion of skin of lid; atropine drops (2 grs. to the ounce—to each eye twice a day); rest in bed.
Progress.—July 26. R. V. 5
12; tension still rather low. The
blood clot present in anterior chamber and also on anterior capsule
of lens renders it difficult to see the fundus clearly; but no
white patches can be made out in the fundus.
July 27. A little blood is still present in the lower part of the anterior chamber. The parts of the retina that were milky have resumed almost their natural appearance, and the changes above mentioned are now represented merely by a faint, whitish, ill-defined stippling of the areas in question. Around the yellow spot is a system of fine radiating lines, which extend for some distance into the surrounding fundus. This is doubtless due to œdema of the retina.
July 28. R. V. 5
6 (i letter); tension still slightly minus. Ecchymosis
present in ocular conjunctiva, but the blood has disappeared
from the anterior chamber. Pupil not so wide as that of
the left eye, although atropine is being used to both. Faint
cloudiness lower third of the cornea, made up of almost transparent
dots, as may be seen with a +20 lens in certain positions
of the eye. Fundus changes have disappeared; faint radiating
lines, however, may still be seen around the yellow-spot region.
July 29. R. V. 5
6 (ii letter) T—I. Pupil now as large as that of
the other eye. Yellow-spot region still surrounded by a wide
band of fine, closely set, radiating gray lines. It may be noted
that the corresponding region of the left (unaffected) eye is encircled
by an ordinary oval reflex.
August 1. R. V. 5
6; (Tn.). A small ecchymosis still present in
the ocular conjunctiva on the outer side of the cornea. No blood
in anterior chamber; no corneal cloudiness. Radiating appearance
still present around yellow spot of fundus.
August 9. R. V. 5
9, L. V. 5
9; (Tn.).
August 12. Vision unaltered. Radiating lines still present around yellow-spot region of affected eye.
September 5. The right pupil rather larger than its fellow, but
no break in the continuity of the edge of the iris can be discovered
to account for this. The action, both to light and to accommodation,
of the pupils is equal. The radiating lines formerly
present around the yellow spot of the right eye have been replaced
by an ordinary oval reflex, like that present in the other fundus.
Tn.; R. V. 5
6 (i letter), L. V. 5
6 (i letter); No. 1 Jaeger read easily.
September 7. Under atropine. R. V. = 5
18 + 1.5 D. Sph.
= 5
5. L. V. = 5
12 + 1.0 D. Sph. = 5
5.