388 BACTERIOLOGY OF THE EYE 



(one with Friedlander's bacillus, the other with Staphylococcus aurais 

 and B. pyocyaneus) ; also the case in which Loeser 1 found B. coli in 

 orbital pus, and a case by Coburn (Arch, of Ophth., 1906, p. 467) with 

 Streptococcus. Reis' case, 2 which resulted from a pustule of the upper 

 lip (Stapliylococci and Streptococci], and in which a circumscribed 

 abscess was formed in the lamina cribrosa of the optic nerve, was 

 considered by the author as infection by way of the veins. The case 

 of Panas 3 was certainly endogenous ; this was very interesting 

 regarding the question of localizing causes. An angioma, which had 

 been partly thrombosed by electrolytic treatment, was infected during 

 the course of a typhus abdominalis. Typhoid bacilli were found in 

 the pus, having probably been conveyed there by the circulating 

 blood. 



Primary osteornyelitic nodules also occur in the walls of the orbit 

 (von Ammon 4 ) ; these are not only tubercular, as is commonly the 

 case in the zygomatic, but also can be due to pyogenic cocci. Morax 5 

 has published interesting results in cases of staphylococcal osteo- 

 myelitis. 



The formation of suppurating periosteal abscesses is also possible, 

 especially after contusions. Careful differential diagnosis in the future 

 will show how far these are due to purely periosteal abscesses, through 

 which the pyogenic organisms in the blood are endogenously located 

 at the site of the contusion, and to what extent primary sinus changes 

 are at work. Trauma, especially contusion, is an important factor in 

 the etiology of empyema. 



In its rare purulent form, tenonitis, occurring in infectious 

 diseases, is certainly a bacterial metastasis. 6 Even in the non- 

 purulent serous forms we must consider the possibility of a toxic 

 cause ; the same considerations are here of importance as in the case 

 of the benign forms of metastatic ophthalmia (cf. p. 364). 



Leaving aside the cases in which the orbit is affected by collateral 

 cedema and infiltration, it is extremely rare for orbital suppuration to 

 result from operations on the eye or its adnexae. 



The orbital tissues sometimes, however, convey an infection 

 upwards to the meninges, especially when an eye is enucleated in a 

 condition of violent panophthalmitis, a procedure which Graefe con- 

 sidered as contra-indicated, but which still finds supporters. Enslin 



1 Z.f. A., 1902, viii., S. 24. 2 A j_ ^ ^05, li x>) S. 155. 



3 A.f. 0., 1904, lix., S. 155. * A.f. A., 1904, xlix., S. 1. 



5 Soc. d'Ophth. de Paris, 1905, ref. K. M.f. A., 1905. i., S. 435. 



6 Fuchs, Mazza, Rollet, Ann. d'Ocul., 1902, cxxviii., S. 52. Bronner. T. 0. S. : 1903, 

 xxiv. 209. Purtscher, Zeiii.f. A., March, 1904. 



