Bilateral Partial Ectasia of the Nerve Head with Peripapillary Ectasia.

GROSS cupping of the disc which is not glaucomatous, associated with a wide scleral halo, or ring, and pigmentary disturbance has been described several times in 'the literature. Itmay be unilateral or bilateral. The visual acuity may be much or little reduced ana the field restricted or normal. Where it is unilateral the'fellow eye may be quite normal. The cup may contain a fine film of bluish-grey tissue. The appearances have been regarded by the authors as of congenital origin. Hancock describes. such a deep cup in a girl of eleven years with vision of 6/36 improving to 6/18 with 15 D. cyl. The other eye was quite normal. The cup was 14 0 D. deep and showed a fine blaish film. Therev.was a wide pigmented halo but the picture indicates thiat the pigmentary disturbance was not marked. The field was difficult to chart but was probably normal. Roenne describes bilateral deep excavation in the cups of a woman of thirty-nine years with no glaucoimatous symptoms. There had been a difficult forceps delivery and there was facial asymmetry. No abnormality in the other members of the family was found. There was a wide halo heavily pigmented at its outer border. In one eye the cup showed a thin bluish film. He quotes Zade and Stock and von Szily (1906) who reported similar cases. Roenne's case is described in an article on congenital anomalies. The right eye was divergent and'almost blind, the left eye was myopic and amblyopic. He calls it pseudo-glaucomatous cupping of the disc. Kraupa describes a similar picture in one eye where the cup was 20 0 D. deep and vision very deficient. The excavation appeared shelved and evoked the description " Terassenformig aufgebautes opticus coloboma."' Young describes the condition of gross cupping without-glaucoma in a woman, aged sixty-two years, in 0.one eye. The other eye was normal. She squinted as a child. 'The tension in both eyes was normal. Visionrin the affected eye which was emmetropic was 6/36, and unimproved. The cup was 5-7 mm. deep. Young th6ught it was quite unlike the ectas'ia seen in microphthalmos, or myopia. He thought it was a congenital anomaly " in the sense of malformation in the evolution of the primary optic vesicle." Q. Di Marzio in his atlas describes under the heading of co,ngenital anomaly, non-glaucomatous