Chapter IX.)

Injuries to the globe of the eye, either direct or indirect, accompanied
most of the orbital wounds.

In some the lesion was of the nature of concussion. In such the bone
injury was usually at the periphery of the orbit, or to the bones of the
face in the neighbourhood. The loss of vision might then be temporary,
persisting from two to ten days, then returning, often with some
deficiencies.

In other similar external injuries, the lesion of the globe was more
severe, and permanent blindness followed.

In variability of degree of completeness, these lesions of the globe
corresponded exactly with those produced in other parts of the nervous
system by bullets striking the bones in their vicinity, and they were no
doubt the result of a similar transmission of vibratory force.

In a third series of cases the globe suffered direct contusion, and in a
fourth was perforated and destroyed.

In cases in which permanent blindness was produced without solution of
continuity of the sclerotic coat, the nature of the lesion was probably
in most cases vibratory concussion and the development of multiple
haemorrhages from choroidal ruptures of a similar nature to those seen in
the brain and spinal cord. The actual haemorrhagic areae varied in size;
but, as far as my experience went, gross haemorrhages into the anterior
chamber did not occur without severe direct contact of the bullet.

In the vast majority of the cases blindness, whether transitory or
permanent, developed immediately on the reception of the injury, and was
possibly in its initial stage the result of primary concussion.

Cases were, however, seen occasionally in which the symptoms were less
sudden, of which the following is an example. I did not think that the
mode of progress seen here could be referred to simple orbital
haemorrhage, although this existed, but rather to intravaginal haemorrhage
into the sheath of the optic nerve. On external inspection the globes
appeared normal.

(76) Wounded at Paardeberg. _Entry_ (Mauser), over the centre
of the right zygoma; the bullet traversed the right orbit,
nose, and left orbit. _Exit_, immediately above the outer
extremity of the left eyebrow.

The patient stated that he could 'see' for thirty minutes with
the right eye and for an hour with the left, immediately after
the injury. He then became totally blind, and has since
remained so. During the next three wee