Extraction of Cataract

In spite of treatment no improvement in vision occurred. On May 16 the left pupil was inactive to light and by June 28 the fundus examination showed a secondary type of optic atrophy with some narrowing of the vessels. 'I'he right eye was normal throughout and, when seen in November 1935, was quite healthy, with 6/6 vision after correction. We infer that the massive lesion of the optic nerve was due to a direct spread of -infection from a focus in the posterior ethmoidal cells and sphenoidal sinus. If so it must have occurred quite at the apex of the orbit. It will be noted that about a couple of months elapsed before the signs of a descending atrophy of the nerve were established by fundus examination. This length of time agrees pretty closely with what one expects in cases of direct tearing across of the nerve in cases of fractured base of the skull. Perhaps after all our patient was fortunate in that the infection confined itself entirely to the nerve and that no backward spread into the cavernous sinus took place. The line that divides two such possibilities must be an exceedingly fine one.