Showing papers in "Archives of Ophthalmology in 1961"

Retinal vascular patterns. IV. Diabetic retinopathy.

Abstract: It is generally held that microaneurysms constitute the characteristic lesion of diabetic retinopathy. First observed by MacKenzie and Nettleship in 1879, 1 the microaneurysms were rediscovered by Ballantyne and Loewenstein in 1943 2 and have been described by numerous clinicians and pathologists since that time. Noteworthy has been the predominant localization of the diabetic microaneurysms in the central and paracentral regions, their random distribution, and their association with punctate hemorrhages and "exudates" in the deep retina. It has also been assumed that the microaneurysms and other evidence of angiopathy in diabetic retinas have a bearing on the glomerular changes in diabetic nephropathy 3-5 and that a clarification of the one might yield useful information for the other. As must be evident from the many reviews which have appeared in recent years, 6-12 the pathogenesis of retinal microaneurysms has been a subject of wide speculation based on some firm evidence but

Ocular involvement in leukemia and allied disorders.

Abstract: It has long been known that the eye is often involved in leukemia and allied disorders. In some reported series clinical observations have been corroborated by biopsy, generally of lids or conjunctiva, and less commonly the globe has been examined. By and large, the exact nature, the extent, and the sites of involvement of the eye by the various reticuloendothelial neoplastic processes remain to be defined. Intraocular leukemic disease has been noted as a discrete tumor mass by Wiener, 1 McGavic, 2,3 Reese, 4 and others; specific consideration has been given to fundus changes associated with leukemia by Borgeson and Wagener, 5 Goldstein and Wexler, 6 Gibson, 7 and Dawson. 8 Involvement of the orbit and adnexa has been well documented, 2,3,9-11 and conjunctival disease has been recorded in many detailed reports. 12,13,14-16 Within the past 2 years we have had the opportunity to examine the globes of 76 patients

Levator resection for minimal ptosis: another simplified operation.

Abstract: In cases of ptosis demonstrating a fair to good levator action, some procedure utilizing the principals described by Blascovic1is still considered the operation of choice. In an attempt to shorten the operative time and simplify the technical difficulties often encountered especially by the ophthalmic surgeon who does ptosis surgery only "occasionally," many modifications of this procedure have been devised and described. In this paper we are presenting another modification of Blascovic's original levator resection intended only for cases of minimal ptosis (3 to 4 mm.) with some function of the levator showing a fair lid fold and in the absence of the "jaw-winking" phenomenon of Marcus Gunn. In our last 4 cases of minimal ptosis we have utilized a simplified and fast procedure (10 min.). Essentially the operation consists of a resection of the levator (or better Muller's and levator), tarsus, and conjunctiva. For this reason, it may

Cell turnover in the adult human eye.

Abstract: Previous reports from our laboratory 1-3 indicate that tritium-labeled thymidine can be used to study cell production and migration following intraocular injection in animals. A recent editorial 4 points out the usefulness of this method of nuclear labeling since the thymidine-tritium is incorporated into cellular desoxyribonucleic acid (DNA) during the premitotic coupling stage of cell division. This stage is normally followed by the remainder of cell division 5 (see text). The tritium tag is qualitatively located and semiquantitatively estimated by means of a high resolution autoradiographic film technique already described in detail for use with eye sections. 1 Studies were carried out on enucleated eyes and luxated cataractous (senile type) lenses of adult humans. Studies on various animal eyes were made for comparative purposes. This report demonstrates the similarities in the location of the germinative regions between the eye of the adult human and that of several animal species. Materials

An anatomical approach to problems of the eyelids and lacrimal apparatus.

Abstract: The title of this paper is somewhat ambiguous in that the eyelids are actually an integral part of the lacrimal system. A better definition might be that the lacrimal apparatus is made up of 3 parts: (1) the secretory system, consisting of the various glands; (2) the distributional system, consisting of the lids which not only carry the fluid to all parts of the conjunctival sac, but also furnish the motor power for the lacrimal pump; and (3) the excretory system. This paper is presented with the hope that a detailed anatomical description of certain parts of the lacrimal apparatus will enable us to select more successful methods of treating its disorders. Anatomy A. The Eyelids. —1. Skin and Subcutaneous Fascia: Although these are 2 distinct entities, they may be treated grossly as one layer which is very thin and somewhat elastic. The palpebral furrows divide it into 2 parts

Retinal vascular patterns. II. Human retinal vessels studied in three dimensions.

Abstract: Trypsin digestion of the retina has been advantageously employed to study the morphology of retinal vessels in flat mounts.1These two-dimensional observations, however, are inadequate for the study of the relationships of the vessels, particularly of the capillaries, to each other at various depths in the retina. It is our purpose in this communication, therefore, to report experience with preparation of trypsin-digested retinas examined in three dimensions. The retinas were first treated with trypsin as previously described.1After incubation the isolated vessels were returned to 10% formalin for 10 or more hours, and then stained either by brief immersion in methylene blue or Paragon solution or by adding a few drops of the dye to an aqueous solution in which the vessels were suspended. The vessels were examined with a dissecting microscope (magnification 2080 ×) while suspended in a water medium or after they had been embedded in

Retinal detachment associated with coloboma of the choroid.

Abstract: This article deals briefly with the embryology of choroidal coloboma, the changes found in 13 persons with colobomas, and some details of the management of 7 cases of retinal detachment observed in eyes with choroidal coloboma. Our material is compiled from the records of the Retina Service of the Massachusetts Eye and Ear Infirmary and the Retina Associates between 1947 and 1959. Coloboma of the choroid is often associated with other pathologic changes in the eye, such as microphthalmos, high myopia, glaucoma, cataract, and phthisis bulbi, so that in many cases the visual function is impaired. Retinal detachment is a real hazard to colobomatous eyes. A brief survey of the literature indicates that observation of this condition is not very rare.1,2,3 The special problems it presents in examination and treatment are discussed in this article. Developmental Pathology of Choroidal Coloboma During normal development the fetal fissure becomes closed by fusion

Limiting membranes of the sensory retina and pigment epithelium. An electron microscopic study.

Abstract: The term "internal limiting membrane of the retina (membrana limitans interna)" has been applied in the past to both the surface created by the inner expansions of Miiller's "fibers" 1 and to the cuticular layer that lies upon them. 2,3 A second cuticular layer or "membrane" is present on the outermost surface of the retina, applied to the bases of the retinal pigment epithelial cells (the inner lamella of the glass membrane of the choroid ). 2 The homology between these two cuticular layers was pointed out by Arey, 4 who also drew attention to a similar homology between the "external limiting membrane of the retina" and a less widely appreciated "membrane" in the pigment epithelium. This latter "membrane" has been known variously as the "membrana reticularis retinae," 5 the "fenestrated membrane," 6 or the "cement substance" 2 of the retinal pigment epithelium. The cuticular membranes (i.e., the internal limiting membrane

Photosensitization of the eye with methoxsalen. II. Chronic effects.

Abstract: Introduction In the first part of this study 1 it was shown that guinea pig eyes can be sensitized to an otherwise harmless kind of energy, long ultraviolet light, with a photosensitizing substance, methoxsalen.* (Since publication of the first paper, additional evidence has been presented that the action spectrum of methoxsalen peaks in the long ultraviolet range.) 2,3 In the first study guinea pigs were exposed to long ultraviolet light continuously for 24 hours. Half of them, the test animals, received methoxsalen intraperitoneally one hour prior to exposure. The harmless nature of long ultraviolet was demonstrated by the controls, none of which sustained ocular injury. The photosensitizing effect of methoxsalen was demonstrated by the test animals, none of which escaped ocular injury. The damage produced was acute and severe. The purpose of the current study was to determine whether a chronic effect could be produced by the daily administration of

The Preservation of Vision by Treatment of Intraocular Tumors with Light Coagulation

Abstract: The opportunity to present the Estelle Doheny Eye Foundation lecture is an honor for which I am very grateful. It is a privilege to pay tribute to the humanitarian goals and generous philanthropy of Mrs. Estelle Doheny and reaffirm the fact that her goals—the preservation and restoration of human eyesight—are and will always be the unswerving objectives of ophthalmology. The Eye Foundation established by Mrs. Doheny represents a manifest expression of her desire to alleviate human suffering and aid in the progress of medical science. This Foundation serves as a constant reminder of true purpose and as a practical aid to scientific accomplishment. For this presentation in honor of Mrs. Doheny, I have chosen to present my experiences with light coagulation in the treatment of intraocular tumors. This report is limited to the technique of treatment and the statistical analysis of results. At this time, the rather short period of

The structure of the vitreous body and the suspensory ligaments of the lens.

Abstract: Several striking morphologic characteristics of the vitreous body combine to make it a unique tissue that has long excited the interest of anatomists and clinicians. These include its paucity of cells and abundance of intercellular materials, its avascularity, its peculiar consistency, and its remarkable transparency. The methods used to demonstrate the structure of the vitreous body have always aroused criticism. The techniques employed have included macroscopic observation of fresh and fixed tissues, histologic study of stained sections, slit-lamp biomicroscopy of the living eye, and ultramicroscopic * examination. The structural framework that was observed with histologic techniques was often dismissed as some form of precipitation artifact. The biomicroscope, introduced near the beginning of this century, enabled the clinician to examine the living tissue. A structural material often described as "sheetlike" in appearance was observed. Unfortunately, the difficulties inherent in producing an acceptable objective demonstration of this skeletal material resulted in a belief

Topical epinephrine therapy of open-angel glaucoma.

Abstract: The last decade has seen renewed interest in topical epinephrine for the treatment of glaucoma. The more frequent use of the gonioprism to distinguish open-angle from angle-closure glaucoma has been an important factor in better defining the use of epinephrine. Tonography and fluorescein-turnover studies have provided some insight into the mode of action of this as well as other agents used in the treatment of glaucoma. In 1951 Goldmann 1 concluded from fluorescein-turnover studies that glaucosan decreased intraocular pressure by decreasing the secretion of aqueous humor. Weekers, Prijot, and Gustin, 2 in a series of 14 patients with chronic simple glaucoma and pressures less than 34 mm. Hg, demonstrated tonographically that topical epinephrine lowered intraocular pressure in the first 48 hours of its use without altering the facility of outflow. In a second group of 7 patients, however, with tensions greater than 35 mm. Hg, they found that topical epinephrine

The conjunctival sign of sickle-cell disease.

Abstract: The purpose of this paper is to report a characteristic appearance of the bulbar conjunctival circulation as a reliable sign in the diagnosis of clinically significant sickle-cell disease. Although general physical examination can offer many clues, it is proposed here that no other clinical observation establishes that diagnosis with as much certainty. Even routine laboratory tests are occasionally inconclusive, for sickled red blood cells are found in patients with the asymptomatic sickle-cell trait. In 1957, Goodman, von Sallmann, and Holland 1 described for the first time vascular loops and segments which were found near the limbus in several patients with heterozygous sickle-cell disease. Bulbar conjunctival changes have since been commented on by Lieb, Geeraets, and Guerry 2 in their monograph on sickle-cell retinopathy. In that report, the following conjunctival abnormalities were noted: icterus, telangiectasis, vascular stasis, and sausagelike dilatations. Their observations indicated a rather low incidence: Of 51 patients with

Data on the natural history of retinal detachment. I. Age and sex relationships.

Abstract: It is universally recognized that retinal breaks play an essential role in the causation of idiopathic retinal detachment; therefore, the term rhegmatogenous * retinal detachment has been coined to denote a detachment resulting from a retinal break. The exact conditions which bring about retinal breaks are still unclear, and it must be admitted that their pathogenesis is largely a matter of speculation. There are 2 approaches which seem to offer interesting possibilities to the problems of retinal detachment. First, it is hoped that our increasing knowledge of the metabolism of the vitreous body will permit a study of the biochemistry of retinal detachment on the molecular level. This would provide a clear understanding of the biochemical mechanisms which culminate in the production of retinal breaks and subsequent retinal detachment. It may eventually be determined that a whole group of chronic conditions are related to the type of metabolic dysfunction which causes

Ophthalmoplegia and retinal degeneration associated with spinocerebellar ataxia.

Abstract: Introduction The predominant ocular findings reported in the familial and heredodegenerative ataxias are nystagmus, optic atrophy, and ocular muscle palsies. Nystagmus is said to be characteristic of the so-called spinal form of familial ataxia (Friedreich's ataxia) and optic atrophy and ocular muscle palsies of the spinocerebellar (Marie's ataxia) and cerebellar forms of heredodegenerative ataxia.1We are concerned in this paper with some aspects of the ocular findings in the heredodegenerative ataxias which fit broadly within the classification of the spinocerebellar and cerebellar forms of the disease. In the literature we found a group of heredodegenerative ataxias associated with progressive ophthalmoplegia, a group associated with retinal degeneration, and a group associated with both ophthalmoplegia and retinal degeneration. Stephans et al.2in 1958 reported 4 cases of heredodegenerative ataxia associated with progressive ophthalmoplegia in which the ophthalmoplegia was characterized by an impairment of upward gaze with a preservation of

Sarcoid of the fundus.

Abstract: Ocular lesions occur in 25% to 64% of patients with sarcoidosis, and many common ocular manifestations, such as the anterior uveitis, are well documented and have recently been reviewed.1,2Involvement of the ocular fundus by sarcoid may occur more frequently than is generally recognized.3,13It is the purpose of this communication to review the reported cases of sarcoid involving the fundus in an attempt to delineate the types of involvement, their frequency, and significance and for diagnosis and prognosis. Analysis of Reported Cases Only 66 patients with demonstrated sarcoidosis and fundus lesions have been reported to date. Of these, 40 are sufficiently well documented to be analyzed in detail. The prevalence of sarcoid of the fundus was nearly the same for both sexes and showed a wide age distribution. The marked preponderance of Caucasian patients may be due to the fact that most of these reports were by

Cataracts in patients with rheumatic diseases treated with corticosteroids. Further observations.

Abstract: A previous communication by the authors related the development of posterior subcapsular cataracts (PSC) to long-term high dose corticosteroid therapy, 1 and a subsequent paper 2 discussed the appearance and differential diagnosis of these cataracts. This report includes additional patients with the same complication and follow-up data on patients previously and presently reported. Methods and Material Collection of data and examination were carried out as outlined in previous papers. The diagnosis was established in all cases by biomicroscopy; patients with other ocular pathology which might be related to PSC were omitted from the series. This series consists of 95 patients. Twentythree of these had rheumatoid arthritis not treated with corticosteroids and thus served as controls; none of the controls developed PSC. Seventy-two patients, 28 of whom have not been reported previously, were treated with corticosteroids; of these 72 patients, 30 developed PSC (Table 2). Medical diagnoses of the corticosteroid treated

Retinal Vascular Patterns: Part III. Age, Hypertension, Absolute Glaucoma, Injury

Abstract: In the first paper of this series we presented observations on normal retinal vascular patterns prepared by a new technique. 1 The retinal vessels and certain adherent structures were separated from the rest of the retina by trypsin digestion and gentle agitation. The isolated network of intercommunicating vessels was then available for study with a variety of stains, unobscured by surrounding tissue which has prevented visualization of the minute vessels and their cells heretofore. In the second paper of this series la we reported on the relation of the capillary plexuses to each other as determined by observing the human retinal vascular pattern in 3 dimensions. The present paper will concern the distinctive vascular patterns found in different age groups and in association with hypertension, absolute glaucoma, and injury to the retina. Subsequent papers of this series will probably be concerned with vascular changes resulting from diabetes and experimental lesions.

Cataracts in rheumatoid arthritis patients treated with corticosteroids. Description and differential diagnosis.

Abstract: A previous report by us 1 has detailed the occurrence of posterior subcapsular cataracts (PSC) in 5 of 22 (23%) rheumatoid arthritis patients treated with 10-16 mg. of prednisone or its equivalent daily for one year or more and in 12 of 16 (75%) treated with 16 mg. or more. The age of the patients and the duration and severity of rheumatoid arthritis showed no significant correlation with the development of cataracts, and since no cataract of this type was seen in 19 rheumatoid arthritis patients who were not treated with corticosteroids, it was suggested that corticosteroids were the chief etiological factor. It is the purpose of this paper to delineate and discuss the cataracts of the above 17 patients from an ophthalmologic orientation. Material and Methods The population was composed of 5 females and 12 males, ranging in age from 34 to 61 years.

Improvement of the Coefficient of Outflow in Glaucomatous Eyes: Prolonged Local Treatment with Epinephrine

Abstract: Epinephrine and other sympathomimetic amines have been used in the treatment of various forms of glaucoma for at least 30 years. Within the last 4 years uniform and reasonably stable preparations of racemic epinephrine bitartrate and l -epinephrine hydrochloride have become available widely for clinical use. When tonography was performed on patients in whom the intraocular pressure (IOP) had been lowered by the addition of one of these preparations to the therapeutic program, in the first few weeks the lowering of the pressure was in most cases the result of a reduction in the rate of production of aqueous humor. This effect has been described most recently by Becker and Ley. When the epinephrine treatment was continued for a period of weeks or months, a different effect was observed in that the pressure remained low and the facility of outflow ("C") became larger. In a majority of the patients so treated,

Ocular Manifestations of Acute Mucormycosis

Abstract: In ophthalmology, as in other fields of medicine, fungus infections have become increasingly important since the advent of antibiotic and steroid therapy. Mucormycosis is a fungus disease caused by normally saprophytic organisms that become pathogenic under special circumstances. Clinically, mucormycotic infections may be classified into chronic and acute (or subacute) types. The chronic type of infection usually occurs as a localized disease process in an otherwise healthy individual, e.g., mucor dermatitis, mucor paronychia, mucor external otitis, etc. These are usually indolent infections and offer no threat to life. Only 3 cases of ocular mucormycosis which could properly be classified as chronic in type have been reported. Two of these were cases of keratomycosis, and one of these resulted from topical antibiotic and steroid therapy for a corneal abrasion. 9,10,41 The third was a case of mucormycosis of the retina presenting clinically as Coat's disease in a healthy youngster. 42 In

The Sudanophilic Granules of the Human Retinal Pigment Epithelium

Abstract: During a study of lipids in the pigment epithelium of the normal human retina, it was observed that there were a large number of round granules, basally located in the cells, which stained with Sudan black B even in paraffin sections. These granules were colored weakly or not at all by the red Sudans and were not visible in sections stained by routine histological methods. The intermingling of sudanophilic granules with the melanin granules gave an initial impression that some of the melanin must be sudanophilic. Examination of unstained sections showed, however, that the majority of the sudanophilic granules were pale, almost colorless forms. This finding was unexpected, since it is generally thought that without special techniques sudanophilic substances are seen in the human pigment epithelium only during disease. It has long been known that the pigment epithelial cells of many lower vertebrates contain lipid inclusions, distinguishable from mitochondria and

Significance of minor eye signs in headache of migraine type.

Abstract: The ocular manifestations of migraine in its various forms may be obvious or subtle. Of the major features, best known, although still of unclear mechanism, are the visual prodromes—scotomas and scintillations—of classic migraine. Rare but no less impressive is the occurrence of temporary or persisting paresis of an extraocular muscle as part of "ophthalmoplegic" migraine. The present report concerns certain less dramatic eye signs: the red and wet eyeball, the small pupil, and the drooping lid, all representing additional clues to the nature of migraine. These minor manifestations are particularly prominent in association with headache occurring in cluster pattern, a form of vascular headache described in this century under many different names. It affects mainly adult males and consists of bouts of high intensity pain of relatively brief duration, rarely lasting over 2 hours. It is almost consistently unilateral and anterior in location, usually surrounding the orbit. Most characteristic is

Pseudomonas Eye Infection as a Cause of Death in Premature Infants

Abstract: An ophthalmologist encounters many perturbing problems but rarely is faced with a patient whose life is in imminent danger Such a situation occurs in Pseudomonas aeruginosa (Bacillus pyocyaneus) infection of the eye of the premature infant, a relatively unknown syndrome that is much more common than gonorrheal ophthalmia and greatly outweighs it in gravity This disease merits the attention of the ophthalmologist Conjunctivitis in the newborn infant is usually due to one of 4 causes: gonorrheal ophthalmia neonatorum, chemical conjunctivitis from silver nitrate, staphylococcic infection, or inclusion blennorrhea Of these, the most frequently considered, and rarest, is gonorrheal ophthalmia, the incidence of which is approximately 02% without silver nitrate prophylaxis and 0013% if the Crede method of prophylaxis is used1Silver nitrate used for prophylaxis frequently causes conjunctivitis in the treated babies Recently, staphylococci have been found to be an increasing cause of conjunctivitis, particularly in hospitals where antibiotic

The nevus of Ota or oculodermal melanocytosis. The ocular changes.

Abstract: Introduction A unique oculocutaneous pigmentation characterized by benign mesodermal melanosis of the paraocular skin and usually the sclera and other ocular tissues was first described and defined as an entity by Ota 18 and Ota and Tanino, 19 under the name of nevus fuscocoeruleus maxillofacialis. Subsequent authors have called it nevus fuscocoeruleus maxillo-facialis of Ota, or, simply, the nevus of Ota. The latter name is the most often used. The terms oculocutaneous melanosis and oculodermal melanocytosis have also been coined to designate the condition. The former of these, we feel, is too easily confused with melanosis oculi, a different condition, as described by Reese. 22,23 The latter, proposed by Fitzpatrick, 9 although graphic, is not widely used. Most of the literature pertaining to this subject has been presented from the dermatologic standpoint and the ocular findings have been, with certain exceptions, incompletely reported. It is the purpose of this paper

Vascular pressure relationships and the intraocular pressure.

Abstract: The intraocular pressure of the eye had been previously reported to be related to the anterior ciliary and vortex venous pressure; however, no relationship has been found between the normal eye pressure and systemic blood pressure. On the other hand, it is well known that acute changes of blood pressure produce parallel changes of eye pressure. It would appear, therefore, that some slowly compensating mechanisms exist to explain the lack of correlation of intraocular pressure (IOP) and systemic blood pressure (B.P.). The two most likely possibilities for this are alterations of aqueous humor dynamics (inflow and outflow), and/or vascular pressure dissociations occurring somewhere between the heart and the exit veins of the eye. The latter possibility, of vascular dynamics, was explored and is the subject of this report. To determine pressure correlations between adjacent arterial systems, measurements were made to correlate (1) systemic blood pressure and ophthalmic artery pressure, (2)

The Diagnosis and Management of Fungus Endophthalmitis Following Cataract Extraction

Abstract: It is not generally realized that so-called delayed infections of the eye following cataract extraction may be caused by fungi of low pathogenicity. Fungal infection, which is becoming an increasingly common complication of cataract extraction, is at present rarely diagnosed clinically. The infection is usually discovered after enucleation, and then only after the eye sections have been subjected to special fungus staining techniques and examination. The major reason for this is that ophthalmologists in general are neither aware of the importance, nor, in some instances, of the very existence of this entity. The relatively benign and slow progression of fungal endophthalmitis resembles that of postoperative iridocyclitis of endogenous origin or low-grade bacterial infection. Treatment with antibiotics and steroids is usually instituted with both of these disorders. This often long-term therapy is not only ineffectual, but may actually promote the growth of the fungus and its extension throughout the vitreous. Most

Necrosis of Uvea, Sclera, and Retina Following Operations for Retinal Detachment

Abstract: In recent years there have been many advances in the surgical treatment of retinal detachments. At the present time the surgeon may choose from a wide variety of surgical techniques. In most of these procedures he detaches one or more rectus muscles and employs transscleral diathermy. In spite of the damage to the blood supply of the eye produced by these techniques, little has been written about the resulting complications. In this report, we will describe the cause and complications of necrosis of the iris, ciliary body, choroid, sclera, and retina following certain operations for retinal detachment. Since the pathogenesis of necrosis of the iris and ciliary body is believed to be different from that of the sclera, choroid, and retina, these 2 groups will be discussed separately. The statistical data used in this report are based entirely on specimens on file at the Armed Forces Institute of Pathology examined

Tropicamide: comparative cycloplegic effects.

Abstract: Tropicamide* (Mydriacyl) is the cycloplegic agent most recently introduced into this country. This, together with cyclopentolate hydrochloride † (Cyclogyl) and homatropine, provides us with 3 so-called short acting cycloplegic drugs for refraction. Inasmuch as these preparations are all parasympatholytic drugs and pharmacologically related, it was decided to evaluate and compare them as to: (1) the effectiveness of cycloplegia, (2) the duration of cycloplegia, and (3) the rapidity of return of accommodation. Emphasis is placed on the clarification of what constitutes adequate and effective cycloplegia. It has been asserted previously by Prangen,1and maintained by Gettes,2,3that there must be less than 2.50 D. of residual accommodation at the time of retinoscopy and examination for a cycloplegic agent to be effective. If the examiner merely desires pupillary dilatation or is unconcerned with the amount of paralysis of accommodation, he should resort to agents which do not affect the ciliary

The Collateral Circulation of the Human Orbit

Abstract: Nine out of 10 persons have a collateral blood supply to the orbit adequate to prevent permanent blindness after a major obstruction of the internal carotid artery or the ophthalmic artery. 26 Certainly the ophthalmic artery is the principal vessel to the orbit, however, its dominance has been overemphasized. There are 5 orbital sites of anastomosis between branches of the internal carotid artery and those of the external carotid artery. All 5 of these collateral channels are described but not emphasized in current textbooks. Collateral circulation to the orbit was illustrated in the human by Soemmerring 1 in 1818, described by DuBrueil 2 in 1847, and discussed at length by Meyer 3 in 1887. Other authors 4-15 between 1874 and the present time have augmented our knowledge. Interest increased as the clinical significance of these collateral pathways in maintaining the circulation to the retina became apparent. Virchow 16 and Fraenkel