The information for this chapter has been gleaned from previous writings and particularly the reports of specimens in the literature. The series of Seefelder, Takashima, Magitot and Lagrange have been most instructive. In addition five specimens have been described by the author for the first time. They are referred to in the following manner: unpublished specimen I, which may have been an example of infantile staphyloma; unpublished specimens II and V supplied by Dr W. A. Fairclough of Auckland—the former was described microscopically by Dr Eisdell Moore; unpublished specimens III and IV supplied by Mr Humphrey Neame, London; and unpublished specimen VI supplied by Dr E. 0. Marks of Brisbane. Dr J. M. Wheeler of New York very kindly sent the author slides of his specimen with neurofibromatosis described in the Transactions of the American Ophthalmological Society, 34, 151 (1936) (Figs. 88 to 94).

INTERFERENCE WITH FUNCTION

The child with hydrophthalmia when first brought to the doctor presents a characteristic picture. The enlarged and hazy cornea is usually obvious. As a rule the head is held down because of photophobia and therefore examination may be difficult. On closer inspection the widening and flattening of the sclero-corneal angle, the bluish sclera and the deep anterior chamber are noticed. Frequently a tremulousness of the iris and a yellowish pupillary reflex are observed in the late stages. The tension is usually raised, and the optic disc may be cupped. Some difficulty in fixation and later partial or complete blindness completes the clinical picture of advanced bilateral hydrophthalmia.

Refraction. Myopia is the most common refractive condition found. It is usually present in only a moderate degree, viz. from 1.7 dioptres, and is not as marked as the increased length of the eye would suggest. The relationship between the length of axis and the degree of ametropia which is nearly constant in myopia, does not hold in hydrophthalmia.

Parsons (1920) gave three reasons why the hydrophthalmic eye is not nearly so myopic as its axial elongation would suggest. They were:

(1) The flattening of the cornea. Its radius of curvature approximates that of the sclerotic and is not uncommonly 11.0 mm. instead of 7.8 mm.