Case of Dislocation of the Crystalline Lens from a blow. By
Francis West, M. D., Philadelphia.
Capt. C., of middle age, and healthy, whilst playing at cards on
board of his vessel, was struck in the eye with the lighted end of
a candle, thrown at him across the table. The blow, which was
not at all seriously designed, was received about midnight, and on
the following morning, at breakfast time, I was sent for to see
him. Entire loss of vision had occurred immediately after the
accident, accompanied with intense pain in the affected eye, which
continued unabated at the time of my visit. There was no external
mark of injury to the eye, but, on examination, the conjunctiva
was found to be considerably inflamed. By considerably dimin-
ishing the light, and then presenting objects of some- magnitude
obliquely to the eye, it was found that the organ still retained
some power of vision, but the effort to look at anything sensibly
increased the pain and uneasiness. The cornea was perfectly
transparent, and permitted a distinct view through the pupil of
the condition of the parts within. With the exception of a very
small semi-lunated portion of its superior external circumference,
which remained clear and black; the pupillary opening presented
a thick, milky, pearl-looking and flocculent appearance, and at
points there were observable small spots of a dense chalky white-
ness, caused by floating shreds of the capsule of the crystalline
lens, which had become opaque. There was no observable effu-
sion of blood in the eye. The iris, towards the inferior and inter-
nal corner of the eye, presented a very marked protrusion, occa-
sioned evidently by the strong pressure of the upper edge of the
lens, which, after having escaped through its lacerated capsule,
was first anteverted, and then thrust downwards and inwards into
the posterior chamber of the aqueous humor, against the iris.
The sensibility of this delicate septum did not appear to be much
impaired, its motions being only perceptibly diminished towards the
internal canthus, by reason of the mechanical pressure which the
displaced lens there exerted upon the iris. The pupil, in conse-
quence of this impeded and irregular action of the iris, assumed a
distinctly ovular shape, with the greatest diameter transversely.
The crystalline lens was, apparently, so tightly impacted in its
unnatural position, that the slight manipulations which it was
thought proper, at the time, to practise upon the globe, exerted no
influence whatever towards its restoration. It was deemed advisa-
ble, therefore, after some very gentle efforts, to test the firmness of
its lodgment, to withhold any other treatment than such as was
required to allay the pain, subdue the conjunctivitis, and prevent,
if possible, the occurrence of more deeply seated inflammation.
With this view, perfect rest was enjoined, wflth constant applica-
tion of cold to the eye, and occasional bathing with an aqueous
solution of opium. These means were successful in reducing the
inflammation present, and quieting the pain which the patient con-
tinued to suffer. In a few days after the accident, all the urgent
symptoms had passed away, and the pupil, throughout the greater
part of its extent, had become much clearer in consequence of the
absorption of the capsular shreds. The lens, however, still re-
mained in its false position, about four-fifths of it being lodged
deeply in the posterior chamber of the aqueous humour. The
sight underwent very little, if any, change or improvement during
the time of my attendance upon him, and at the end of a week he
returned home in his vessel. This short period did not, of course,
admit the expectation of any decided alteration in the condition of
the crystalline lens, which could be effected only, as was supposed,
through the agency of absorption.
I received a letter from my patient’s friends in the course of
about a month after he left Philadelphia, up to which time he
stated that no further unpleasant symptoms had occurred, and that
he thought he was regaining slightly the power of vision.
It is matter of much regret that the result of this case could
not have been positively ascertained, as the want of such know-
ledge materially diminishes its interest and utility.
In regard to the exact mode by which the blow from the candle
produced the injury to the eye, it may be questioned whether it
was by the direct impulsion of the foreign body upon the globe of
the eye, or by the sudden and violent contraction of the muscles of
the lids, induced by the natural and instinctive disposition of the
eye to protect itself from the contact of external substances. We
incline to the belief that the latter is the more satisfactory expla-
nation of the phenomenon.
In regard to this instinctive vigilance of the eye-lids, it is well
known that, now and then, it is eluded by foreign substances, which
thus gain access within their enclosure. A curious instance of the
kind recently came under my notice. A jeweller, who was melt-
ing some solder, imprudently poured the fluid, whilst boiling, from
the original vessel into another one, which happened to contain some
water ; an explosion at once occurred, and a considerable portion
of the melted solder found its way into one of the poor fellow’s
eyes. I saw him in a few moments afterwards, and on separating
the lids, I discovered that the space between the lower one and the
globe was completely occupied by a solid coat of the metal, which
was at once removed by the forceps. It presented exactly the
mould of the lower section of the eye, being semi-lunated in form,
and about one fourth of an inch in diameter; in thickness it was a
line or more.
Mackensie and other writers upon the diseases of the eye, have
related several instances of dislocation of the crystalline lens simi-
lar to the above, but according to the maxim “ observationes ad-
denda sunt,” I thought it might be worth while also to place the
present one upon record.