THE INFLUENCE OF TRAUMA UPON THE ONSET OF INTERSTITIAL KERATITIS

THE relationship of an accident or a trivial trauma to interstitial keratitis has received little attention in this country, but it is a question of the greatest importance from the point of view of the Workmen's Compensation Act. I have been through several years of the volumes of THE OPHTHALMOSCOPE and THE BRITISH JOURNAL OF OPHTHALMOLOGY, and I have found practically nothing bearing on the subject. German statistics admit that in about 3 per cent. of cases there is a history of an accident, but there is a tendency to regard the trauma rather as a coincidence than as a causal factor. I personally had no idea that there was any such causal relationship till the matter was brought to my notice by a paper read by Mr. Coulter at the Oxford Congress. This will be found in the BRITISH JOURNAL OF OPHTHALMOLGY, Vol. II, page 139. Mr. Coulter could find but three references in the literature referring to the subject. When I heard the paper I remembered that I had seen more than one case of interstitial keratitis in which I had obtained a history of an accident, but I had regarded the association as merely a coincidence or, at any rate, a rare determining cause. At the recent Congress of the Ophthalmological Society in London, Mr. Cunningham read a very interesting statistical paper upon the disease, and he found a history of accident in 3 per cent. of his cases. In the discussion which followed, Mr. Spicer stated that he thought that 3 per cent. agreed with his experience. I think, then, that we may take it that the general opinion of ophthalmologists is that about 3 per cent. of all cases give a history of accident. After hearing Mr. Coulter's views, and those expressed in the discussion of his paper I gave special attention to the matter, and at the Birmingham Eye Hospital we found case after case coming up with a history that the attack had been brought on by an accident. I have had to report on three or four -of them for compensation. One of the very first cases of the kind was operated upon by me some ten years ago for senile cataract. After the operation an opacity appeared in the centre of the cornea, and this developed