1923- -^'>- 23. A CASE OK CONGENITAL MIOSIS. 1 I 



that a possible explanation of the figure is that the pull has been so str«^ng 

 that the most central ciliary process has been drawn a little way into the 

 iris. A dislocation of the ciliary processes has consequently taken place in 

 a central direction. 



In order to give the reader an idea of the completeness of the ab- 

 sence of the dilatator in the outermost part of the iris, I have added a 

 photograph (fig. 1 1 1 of the iris immediately before the ciliary processes are 

 reached, and for comparison have photographed the same spot in 2 normal 

 eyes taken from persons of about the same age as Axel B. (figs. 12 & 13). 

 The difference between the miotic eye and the normal eves is striking. 

 The photograph of one of the normal irides (from a woman rather older 

 than A. B.I is interesting on account of the club-shaped swelling which the 

 dilatator exhibits before it ends. 



These reflections upon the peripheral part of the iris where the dilata- 

 tor is absent might therefore naturally lead to the assumption that the 

 "projection" has originated in a gradual dislocation, by the contraction of 

 the sphincter, of the fixed attachment of the dilatator muscle, which hrs 

 been drawn in towards the sphincter until at last it lies a little within the 

 intermediate zone. It is a question, however, whether this explanation, 

 plausible though it may seem, is correct, for the fact is that now and again 

 other things have been found in connection with the "projections", which 

 do not harmonise with this assumption. One of these is that not infre- 

 quently, just outside — i. e. peripherally with regard to — the "projection" 

 in the stroma, an "epithelial process" is found in the shape of a long rod cr 

 a diverticulum, which is attached to the iridian epithelium. Fig. 14 shows 

 one of these. The photograph was taken from a series in which the sec- 

 tions were only 5 11 in thickness, and the section photographed had curled 

 up a little; hence the indistinctness in the upper part of the figure. 



Fig. 15. shows another diverticulum, more highly magnified; and here 

 the connection with the foremost cell-layer in the iridian epithelium is very 

 distinct. These epithelial processes are sometimes surrounded with a la\er 

 of contractile fibrils, which again are sometimes absent. They consist of 

 pigmented, fusiform epithelial cells. It is a very peculiar and striking phe- 

 nomenon that these "epithelial processes" a/-a'a\'s turn out towards the ciliary 

 bodv. \'erv occasionally I have been able to follow one in the series right 

 up to a ciliary process, but in general they do not reach far enough to 

 stand in any relation to these processes. While engaged in this work, I 

 have often asked mvself why these epithelial processes alwavs turn outwards 

 and never inwards, centripetally, but I am unable to give a satisfactory 

 answer. I have thought that perhaps the reason was to be found in the 

 m.e^hanical conditions. As the dilatator practically speaking alway ends in 

 a "projection", and as the sphincter, when contracting, must necessarily 

 draw the end of the dilatator in towards the pupil, because that muscle 

 has no firm attachment to the periphery of the iris, it might be imagined 



