EyeRounds Online Atlas of Ophthalmology
Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry
*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.
Category: External Disease
Phthisis bulbi following perforating smallpox ulcus serpens
Phthisis bulbi frequently resulted after a smallpox ulcus serpens perforated the cornea. The indentations corresponding to positions of the rectus muscles is pathognomonic for the diagnosis of phthisis bulbi and signifies the demise of the disorganizing, shrinking eye.
Some use the term "atrophia bulbi" for shrinkage of the eyeball wihout perforation and restrict the use of "phthisis bulbi" to atrophy with disorganization after perforation of some part of the eyeball..
Smallpox was complicated by an hypopyon ulcer. The ulcer perforated the cornea. This led to phthisis bulbi. This led to the unusual deformation of the cornea that is vividly evident in the photo..
Total blindness resulting from phthisis bulbi due to perforating hypopyon ulcers during smallpox attack
One of the greatest accomplishments in the history of medicine if not mankind was the elimination of smallpox from the face of the earth. This was an accomplishment not of ophthalmologists' but of public health physicians' and their associates'. When one has examined hundreds and hundreds of patients blind from smallpox, it is beyond belief that that disease has been absolutely eliminated. The photo demonstrates the prototypical patient irreparably blinded by smallpox.
Phthisis bulbi, both eyes, no light perception
Another typical case of smallpox blindness - 1962.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.