THE ORBIT 387 



eye was infected rnetastatically. But such is unlikely. Though a transference of 

 toxins from the nose or nasal sinuses into the eye has so often been put forward, 

 such has never been proved beyond all doubt to have occurred in any single case. 

 The occurrence of bulbar inflammations in these (nasal) affections can quite as well 

 be explained by a localizing and predisposing reflex circulatory disturbance, due to 

 the neighbouring affection, while the true exciting cause of the iritis, scleritis, etc., 

 is perhaps something quite apart from the nose. 



The rare cases of orbital cellulitis in infants cannot be associated to 

 the same extent with affections of the sinuses, as the sinuses are either 

 absent or undeveloped up to the eighth year. In the case of infants 

 during the first few weeks 1 infected birth wounds should be considered. 

 In older children - lid infections are possible causes by metastasis. It 

 is only after the sixth year that a nasal etiology becomes important. 

 The youngest person whom I have seen with an orbital abscess which 

 certainly originated from a sinus (sphenoidal containing Streptococci) 

 was nine years old. 



In encapsulated empyemata the organisms die out with varying 

 rapidity. The contents of a mucocele, according to my experience, 

 are mostly sterile. Such an encapsulation is rare in the orbit. Still, 

 a case is reported by Hirsch 3 in which the pus was sterile. 



It is interesting that orbital infections can occasionally lead merely 

 to an infiltration. These cases, which are often confused with 

 tumours, can resolve without suppuration. This is the condition 

 present in some at least of those peculiar cases of exophthalmos, 

 which disappear after resection of the external wall of the orbit, 

 though 110 pus or tumour has been found. I have had a case in 

 which, on opening the orbit by a Kronlein, the orbital tissues were 

 found to be densely infiltrated, and only after eight days the pus was 

 discharged (Stapli. aureus).* Many of the transient orbital swellings 

 associated with sinus empyemata must be considered to be collateral 

 toxic inflammatory cedemas. 



The occurrence of metastatic orbital inflammations cannot, however, 

 be disputed. 5 Two cases of orbital suppuration recorded by Pergens 6 

 can be considered, with some probability, to have been metastatic 



1 Divjardin, Jmr. des Sciences Med. de Lille, 1888, p. 169. Leplat, Soc. Beige d'Ophth., 

 November, 1897 (Staphylococci). Orlandini, La Clin. Ocul., 1904, p. 1173. 



2 Cabannes and Lamarque, These de Faure, Bordeaux, 1903 (two years old, Pneumococci) . 

 Trousseau, Ann. d'Ocul., 1898, p. 343 (nine months old, Streptococci and Staphylococci). 

 Miiller, Inaug. Dissert., Wurzburg, 1905, p. 29. 



3 Prager Med. Woch., 1894, No. 14. In seven cases of orbital cellulitis there was only 

 one which was probably metastatic. 



4 Cf. Gruber's Dissert., Freiburg, 1902. 



5 Cf. the dissertation of Schwend, Basel, 1899 ; also a probable case by Axenfeld, 

 A.f. 0., 1894, xl. 127 ; also Miiller, Dissert., Wurzburg, 1905, p. 35 (Streptococci). 



6 Ann. d'Ocul., cxiv. 278. 



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