At the time of the American Revolution, understanding of diseases of the eye was rudimentary, treatment of ocular problems was largely ineffective, and American physicians were highly dependent on their European colleagues for training and development. Knowledge of optics, light and color was somewhat more advanced. The author reviews the state of eye care during the Revolutionary period, historically and anecdotally, with references to the literature of that time.

Blindness↗

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Sympathetic ophthalmia. Ample room for controversy.

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Diagnosis, Differential↗

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Vitreous hemorrhage complicating retinal astrocytic hamartoma.

Tuberous sclerosis classically presents a triad of mental deficiency, seizures and adenoma sebaceum. Among the ocular manifestations are astrocytic hamartomas in the retina. This paper describes the case of a 24-year-old man with tuberous sclerosis who had recurrent vitreous hemorrhage from a large epipapillary astrocytic hamartoma in the left eye. Pars plana vitrectomy cleared the vitreous and bimanual bipolar coagulation of tumor bleeding points was done. Fragments of the friable tumor were obtained with the vitrectomy instrument and were prepared for tissue culture, histology, and electron microscopy. Although pars plana vitrectomy offers certain advantages over other methods of biopsy, it does present a danger of extraocular seeding of malignant cells; therefore, it is not recommended in cases with probable intraocular malignancy.

Adolescent↗

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The Harrower collection and its place in the history of ophthalmic pathology.

A set of ophthalmic pathology slides made in 1882 by Dr. David Harrower, a Massachusetts physician who studied at Moorfields Eye Hospital, and Mr. W. Jennings Milles, the curator of Moorfields, are reviewed. They are of historical significance, as they were made at a time when microscopic examination of ocular tissues was first being introduced, and they represent one of the earliest examples of the use of celloidin for embedding ocular tissue. The slides are well preserved and contain cases demonstrating a wide spectrum of ocular pathology. The Harrower collection is possibly the oldest existing slide collection of ophthalmic histopathology.

Choroid Neoplasms↗

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Choroidal halo nevus occurring in a patient with vitiligo.

A halo nevus of the ocular fundus is described in a patient with vitiligo and history of malignant melanoma of the calf excised six years previously. The significance of halo nevi is discussed.

Choroid Neoplasms↗

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Cocaine's use in ophthalmology: our 100-year heritage.

One hundred years ago the fledgling ophthalmologist Carl Koller demonstrated that the alkaloid cocaine was a local anesthetic suitable for rendering the eye temporarily insensible to pain. It was an event of historical significance, as his discovery opened the door not only to a new era in ophthalmic surgery, but to surgery in general. In this paper we review the ancient uses of the coca leaf, the historical events leading up to and following Koller's discovery, and the present day uses of cocaine in ophthalmology and medicine.

Anesthesia, Local↗

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Frick's Treatise on the Diseases of the Eye.

George Frick, generally regarded as the first American physician to limit his practice to ophthalmology, was also the first American to author a textbook on the eye. In this historical article, the author describes Frick's education under his two great mentors, Philip Syng Physick and George Joseph Beer, and reviews Frick's book: A Treatise on the Diseases of the Eye; Including the Doctrines and Practice of the Most Eminent Modern Surgeons, and Particularly Those of Professor Beer.

Books↗

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Willard Parker's 1841 orbital operation.

There are few records detailing the techniques and tribulations of early American surgeons who dared venture into the treacherous recess of the human orbit. The authors present a recently discovered letter written by a young woman who in 1841 underwent an orbital operation performed by the prominent New York City surgeon, Willard Parker. The letter details the patient's experiences in an era without anesthesia or antibiotics, and her subsequent development of conjunctival adhesions.

Female↗