Ophthalmoplegia externa complicating a case of Graves' disease / by Francis Warner.

  • Warner, Francis, 1847-1926.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmoplegia externa complicating a case of Graves' disease / by Francis Warner. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Early in April she was troubled with corneitis, attended with great photophobia, which attacked the left eye principally, and lasted nine days ; a relapse of corneitis occurred in the right eye for five days, attended with a stye in the lower lid, each attack of corneitis being attended with a gastric crisis/^ Mr. James Adams kindly saw the patient with me, and we took the following note :—Diplopia, external strabismus (very slight), proptosis, traces of corneal ulceration. The movements of either eye were very deficient; in the right eye there was vertical movement through about 4°, but in the horizontal plane not more than 2°; it was also specially noted that the left eye, while it could move outwards, had no power of inward movement. The pupils were both sluggish in movement, but reacted to light and accommodation, the left acting better than the right. Either eye could read type J. 1 at six inches. During May there were several gastric crises with severe headache. Examination for spinal symptoms showed the absence of the signs of ataxy, and the knee jerk was normal. As she lay in bed there was distinct tremor of the feet, increased by any mental excitement, and this remained constant. The legs were slightly oedematous. Pulsation in the thyroid diminished, and the general condition improved, but the goitre did not lessen in size. The condition of the eyes continued to distress the patient; there was great photophobia caused by ulcera- tion of both cornese, which occurred principally on their lower segments, and was probably due to exposure at night following upon the weakened condition of the facial muscles; there was proptosis, together with palsy of the fifth pair of nerves; the left eye again being the worst in extent of ulceration and amount of pain. Iced com- presses were applied during the day, and a bandage at night; a leech placed behind the ear gave relief to the pain and conjunctivitis on that side. During June the general comfort of the patient con-