THE ORBIT 391 



severe, and rapidly end in death. 1 I have been able, as the accom- 

 panying figure shows, to follow the Pneumococci in the case of a 

 patient with meningitis far into the orbital tissues. 



Weeks has observed an orbital cellulitis following on an abscess of 

 the forehead. 2 



Naturally, orbital cellulitis can develop as the direct result of 

 injuries or of infectious processes (trauma, furuncle, etc.) in the parts 

 around, as in the case by Laas 3 which followed a furuncle of the nose, 

 and gave Stapliylococcus aureus on cultivation. These cases are an 

 intermediate stage to the infectious phlebitis forms. 



A sharp differentiation between orbital cellulitis and thrombo- 

 phlebitis is impossible in many cases. Those cases which arise from 

 the cavernous sinus are the purest cases of thrombo-phlebitis. 



[A case of orbital cellulitis, resulting fatally, was reported to the 

 Ophth. Soc. by Snell ; see T. 0. S., 1906. The source of infection was 

 a vesicle on the lip. A. M.J 



Infectious thrombo-phlebitis ophthalmiea 4 arises partly in an 

 ascending manner from before (infected wounds and septic infections 

 of the skin and its glands, etc.), partly descending from a septic sinus 

 thrombosis, which itself can arise from many sources (ear, naso- 

 pharynx, sinuses, tonsils, or as a metastasis in the course of infectious 

 diseases and septic conditions). The bacterial findings in the disinte- 

 grated and infected thrombi are not always those which the original 

 affection would lead us to expect. 



Thus, resulting from a furuncle in the surrounding parts, Nonne, Cabannes, 

 and Axenfeld found Stapliylococcus in the veins ; Villard found Streptococci after 

 furuncles of the nose ; Mitvalsky, whose researches are especially important, found 

 Pneumococci and Pneumobacilli in a thrombo-phlebitis developing from an affec- 

 tion of the tonsils, and Staphylococcus in another case which occurred after 

 erysipelas. 



It is a strange fact that occasionally after a process on the one side e.g., a tonsil- 

 litis by the intermediary of the cavernous sinus a septic thrombo-phlebitis of the 

 opposite side can occur (Leber, Panas, and Terson). 



1 Of. the literature given by Axenfeld, Monatssch. f. Nervenh., 1897, i. 415 ; also by 

 Uhthotf, Heidel. Couf., 1905. The case of Hoffmann is quite exceptional; there, after a 

 meningitis, an encapsulated abscess was demonstrated in the optic sheath. 



2 Ann. d'OcuL, 1901, cxxvi. 66. 



3 Z.f. A., 1902, vii., p. 179 ; here the literature. 



4 Bacterial findings : Of. Giinsburg, IVjcstnik Oft., Jiily, 1895, and Arch, d' Ophth., 1896, 

 xvi. 380. Mitvalsky, ibid., 1896, xvi. 22. R. Hoffmann, Z. f. A., 1906, xvi., Ergzgsh. 

 Terson, Eecueil d' Ophth., 1893. Eversbusch, Leber, loc. eit. Gillet, These de Paris, 1905. 

 Stocker, Arch. f. Aucjenh., 1901, xxxiv., S. 195. Villard, Arch. d'Ophth., 1895, xv. 477. 

 Muller, Dissert., Wurzburg, 1905. Nonne, Munch. Med. Woch., 1904, S. 943. Cabannes, 

 Jour. Med. de Bordeaux, 1904, ref. Michel-Nagel. Rochon-Duvigneaud and Onfray, Arch. 

 de Med. des Enfants, 1905, S. 537 (Staphylococcus aureus). Morax, Soc. Franc. d'Ophth., 

 1905 (Streptococci and Staphylococci). Bartels, A.f. A., 1906, Ivi., S. 267. 



