ension, _i. e._, the amount of fluid injected
beneath conjunctiva may overcome the stagnation in the lymph passages,
flush out these channels and improve ocular elimination.

Fischer in a personal letter says:

"You have two possibilities for the production of glaucoma with sinus
disease: A toxic factor due to poisons being carried into the eye; and
second, interference with a proper blood supply to the eye through
compression of the efferent or afferent blood vessels supplying the eye
from edema of the tissues about the eye consequent upon the sinus
infection. Either is associated with the production of substances which
increase the hydration capacity of the ocular colloids."

If such is the case why could not the existence of pyorrhea and blind
abscesses about the roots of the teeth be the source of the toxic
factors mentioned by Fischer? Hence the suggested association of the
dental surgeon with the ophthalmologist in these cases of apparently
idiopathic increased intra-ocular tension.

It would be well to state here a cursory examination of the mouth will
not discover root abscesses any more than such examination will
discover non-suppurative sinus disease. A careful examination of each
tooth together with radiograms of the entire maxilla are absolutely
essential to determine their presence or absence.

Trephining for Glaucoma

BY

ROBERT HENRY ELLIOT, M.D.,

London, England.

Mr. President and Members of The Chicago Ophthalmological Society:

As the hour is late I propose to take up only the principal points in
connection with my subject and to deal with each one shortly.

First: The operation of trephining is suitable, not merely for chronic
cases, but for sub-acute and acute cases of glaucoma as well. I would
urge on your attention that, of all the operations dealing with
glaucoma, this one involves the minimum of surgical violence, and
should, therefore, in acute cases be the operation of choice. It is,
moreover, much safer than any other operation I know of, and is no less
certain in its results. I do not advise trephining in the secondary
glaucoma following intumescent cataract, for in such cases the
semi-fluid lens bulges into and blocks the trephine hole. Nor for
obvious reasons do I recommend it in cases where there is reason to
believe that a communication exists between the aqueous and vitreous
chambers.

Second: The object of trephining is to tap and permanently drain the
aqueous