ks there were occasional
'flashes of light' experienced, but these then ceased.

At the end of three weeks the condition was as follows: Ocular
movements good in every direction except that of elevation of
the globe. The levator palpebrae superioris acted very slightly;
the right, however, better than the left.

There were marked right proptosis, less left proptosis, and
slight patchy subconjunctival haemorrhage of both eyes. The
pupils were dilated, motionless, and not concentric.

The patient was invalided as totally blind (November, 1900).

Mr. Lang, who saw this patient on his return to England, kindly
furnishes me with the following note as to the condition. There was
extensive damage to both eyes, haemorrhage, and probably retinal
detachment as well as choroidal changes.

The quotation of a few illustrative examples typical of the ordinary
orbital injuries may be of interest:--

(77) _Vertical wound._--_Entry_, into left orbit in roof
posterior to globe, and internal to optic nerve; _exit_, from
orbit through junction of inner wall and floor into nose.

Complete blindness followed the injury, but upon the second day
light was perceived on lifting the upper lid. There was marked
proptosis, subconjunctival ecchymosis, swelling and ecchymosis
of the upper lid, and ptosis. Anaesthesia in the whole area of
distribution of the frontal nerve.

At the end of three weeks, fingers could be recognised, but a
large blind spot existed in the centre of the field of vision.
The general movements of the globe were fair, but the upper lid
could not be raised. The proptosis and subconjunctival
haemorrhage cleared up.

Little further improvement occurred; six months later the
patient could only count the fingers excentrically. A very
extensive scotoma was present. The optic disc was much
atrophied, the calibre of the arteries diminished and the veins
full (Mr. Critchett). The ptosis persisted. It was doubtful in
this case whether the ptosis depended on injury to the nerve of
supply, or on laceration and fixation of the levator palpebrae
superioris. The latter seemed the more probable, as the
superior rectus acted. The absence of any sign of gross
bleeding into the anterior chamber is opposed to the existence
of a perforating lesion of the globe in this case.