The Sämisch case and the Müllers of Wiesbaden.

PURPOSE: There are significant inconsistencies in accounts in textbooks of the fitting in 1887 of a device resembling a scleral contact lens. The aim of this study was to establish the facts of this case and to provide an overview of the subsequent clinical performance of blown scleral shells and lenses. METHODS: A literature search was conducted that included the original report published in 1910 of the fitting of the patient. The dimensions and back vertex power of a blown scleral shell were measured. RESULTS: In 1887, the right eye of a patient with lagophthalmic keratitis as a sequel to cancerous destruction of the lower eyelid was fitted with a protective blown scleral shell. His left eye was effectively blind. The referring ophthalmologist was Professor Theodor Sämisch of Bonn and the fitting was undertaken by the firm of F Ad Müller & Söhne of Wiesbaden, Germany. With periodical replacement, a shell was worn for at least 21 years. Müller scleral shells were principally fitted in keratoconus providing markedly improved visual acuities and wearing times of up to 14 h a day. There were instances of continuous wear. CONCLUSIONS: Failure to consult original sources is responsible for errors in descriptions of the Sämisch case that is of historical importance because it represents both the first use of a therapeutic contact shell and the first instance of continuous wear. Blown scleral shells and lenses played an important part in the optical correction of keratoconus and the management of other ocular conditions during the first quarter of the 20th century.

[Chalazion or basalioma in an oil painting of the National Portraits Gallery in London]. / Chalazion oder Basaliom auf einem Olgemälde der National Portrait Gallery in London.

Using an oil painting by G.F. Watts displayed in the National Portrait Gallery of London, we made an attempt to diagnose the dermatological alterations recognizable.

Squamous cell carcinoma of the eyelid.

The occurrence of squamous cell carcinoma of the lid is reviewed with emphasis upon the incidence, clinical presentation, pathophysiology and methods of treatment. Squamous cell carcinoma accounts for about 9% of all eyelid malignancies, although it is frequently over-diagnosed by pathologists and confused histologically with other benign entities. This lesion occurs most commonly in elderly, fair-complexioned individuals with a history of chronic sun exposure and skin damage. In the lids, squamous cell carcinoma shows a variety of clinical appearances although it usually presents as a painless, hyperkeratotic lesion that gradually enlarges and eventually ulcerates. There is a tendency for lower lid and lid margin involvement. This potentially lethal neoplasm is capable of aggressive local spread or metastasis to regional lymph nodes. The development of squamous cell carcinoma is thought to progress through phases of intraepithelial squamous dysplasia and intraepidermal squamous cell carcinoma before invasive squamous cell carcinoma occurs. Various treatment modalities have been advocated including surgical extirpation with histologic control, radiation therapy and cryotherapy.