Dendritic ulcer treated with cortisone.

CASE REPORT Mrs. R. O'N., aged 68, was admitted to St. Mary's Hospital, under the care of Mr. Williamson-Noble on January 12, 1951. Her complaints were pain, redness, and diminished vision in the right eye since the latter part of December, 1950. History.-Her ophthalmologist stated that her left eye has been blind for 40 years after a traumatic retinal detachment. The right eye showed a dendritic ulcer when she first came to see him on December 27, 1950. The ulcer was carbolized and ung. atrop. 1 per cent. prescribed, but, the intra-ocular pressure rose and the cloudiness of the cornea became worse. The treatment was changed to gutt. eserine * per cent. and pilocarpine 2 per cent. The pupil became smaller and the pain was relieved but the tension remained high. Examination.-Right eye: visual acuity 3/60 with glasses. The lids were normal and there was no regurgitation from the lacrimal sac on expression. The general appearance of the eye was red and angry. The cornea appeared hazy on account of generalized oedema, and on staining with fluorescein revealed a central dendritic ulcer resembling the letter W with knobs at thQ junctions of the strokes. Striate keratitis was marked and corneal sensation was completely absent. The anterior chamber appeared deep and the pupil was moderately dilated, and inactive with posterior synechiae. The iris was difficult to see. A dull red reflex was present, but retinal details could not be discerned. Left eye: visual acuity no perception of light. The eye was white with retinal detachment present below. Schiotz reading on admission for the right eye were 4.5/7.5, 34 mm. Hg; 7/10, 32 mm. Hg. X rays of jaws, chest, and sinuses as well as blood investigations were negative. Treatment.-The patient was put to bed and given oily eserine 1 per cent. to the right eye every half-hour for 2 hours, then every 2 hours for 8 hours, and finally three times daily; gutt. aureomycin t per cent. every 3 hours; hot bathing to the right eye 4-hourly with continuous dry heat between; sedatives and laxatives as required. The following day a spastic entropion of the right lower lid was noted. The pupil was now smaller, about 3 mm. in diameter. Schiotz readings were 5/7.5, 32 mm. Hg; 8/10, 28 mm. Hg. The condition of the eye remained the same and the patient was started on a 5-day course of sulphatriad, 2 g. as the initial dose followed by 1 g. three times a day. This treatment was carried out until January 17, 1951, when the aureomycin drops were discontinued, the ulcer was carbolized, and gutt. albucid 1 per cent. OH3 substituted. Ascorbic acid orally 200 mg. three times daily was ordered. After 3 days the ulcer lost its characteristic appearance and was replaced by a few linear central stains. The generalized corneal oedema persisted, the eye was still angrily injected, and the Schiotz reading was 7.5/7.5, 22 mm. Hg; 10/10, 20 mm. Hg. The tension in the right eye continued normal and on January 22, 1951, it was decided