17,1 Ubaldo: Clinical Forms of Panophthalmitis 67 
SYMPTOMATOLOGY 
In most cases the loss of vision was more or less complete, 
with pain and tenderness in the eyeball, lachrymation, and 
photophobia. As objective symptoms there were redness of 
the eye, swelling with more or less complete closure of lids, 
conjunctivitis, congestion and cedema of the conjunctiva, kera- 
titis, hypopyon, some discharge, and opaque cornea. 
s A case is on record of fatal streptococcia with panophthalmitis, 
in which the patient was suffering from acute rheumatism. 
Blood cultures were positive for streptococcus. De Schweinitz 
also reported a case of bilateral metastatic ophthalmitis in 
puerperal pyzemia, with recovery of the patient but with loss 
of vision in both eyes. Bacteriological examination of the con- 
junctival secretion showed the streptococcus pyogenes. (1) 
I also had a very good case of metastatic panophthalmitis 
or choroiditis in an old woman, 55 years of age, who was suf- 
fering from multiple abscesses of the left arm and chest. By 
a coincidence, the left eye was the one affected. The affection 
began by immobility of the iris, dimness of vision, whitish lens, 
and later pain in the left side of the face and chemosis of the 
conjunctiva, followed by extensive cedema of the lids, and the 
iris could not be dilated with atropin. In less than a week 
the condition became markedly worse; the cedema of the lids 
was so bad as entirely to preclude their opening, even with the 
help of lid retractors. The size and tension of the eyeball in- 
creased, and clear symptoms of panophthalmitis became evident. 
Enucleation confirmed the diagnosis, considerable ee matter 
exuding from the removed eye. 
The symptoms of the traumatic cases were different. There 
was a case of a perforating wound of the cornea due to trauma 
by a piece of sharp-pointed stick of bamboo, which affected 
even the iris. However, the patient could still count fingers. 
The wound was apparently closed and there were signs of only 
mild inflammation of the eye. 
TREATMENT 
When we have before us a case of an injured eye, the first 
question which comes up is, whether the wound is perforating 
or not. The next question is, whether the wound is infected 
or not. When infection with suppuration is present, one must 
determine whether the suppuration is localized in the anterior 
chamber or has extended to the vitreous. These are the prob- 
lems before the specialist. 
