Scleral gumma.

A married woman aged 47 years came to the Chatterjee Memorial Eye Hospital on November 2, 1954, with the history of sudden onset of pain and tenderness of the left eye 3 weeks previously. Since then she had noticed a small abscess-like swelling with redness around it in the upper part of the eyeball. Examination.-An almost round punched-out hole in the sclera was seen near the 12 o'clock position about 2 to 3 mm. above the limbus. The uveal tissue underneath was exposed over an area of 2 mm. diameter, and was covered by the conjunctiva which was raised like a bulla over it. There was swelling and congestion of both conjunctiva and episcleral tissue around the opening, which simulated a trephine hole stretched somewhat vertically (Figure). The anterior chamber and the other parts of the eyeball, the eyelids, and the right eye were all normal. Previous Illness.-She had had smallpox at the age of 8 years, and inflammatory painful pelvic disorders associated with discharge of blood and pus at the age of 17 years about I1I years after her marriage. The first and only pregnancy was at the age of 19. She had suffered from occaFIGURE.-Position of scleral gumma. sional fits since then but was cured after an operation for dilatation and curetting of the uterus. She had had pleurisy without recurrence at the age of 37 years. Investigation and Treatment.-The vision in the affected eye was 6/6 without glasses. Pupillary reaction to light and convergence were normal. The fundi were normal. Slit-lamp microscopy of the left eye under mydriasis showed a few opaque areas in the cortex of the lens beneath the anterior capsule near the equator in the 10 to 11 o'clock position. There were no pigment or cellular deposits on the surface of the anterior capsule. No keratic precipitates were found. The anterior chamber was normal in both eyes. The intra-ocular tension was 18 to 20 mm. Hg (Schiotz) with or without mydriasis. Both the Wassermann reaction and Kahn (flocculation) tests were positive