N O T E S , C A S E S , I N S T R U M E N T S 303

source in a battery handle. The light can be turned on and off by pushing a button on the handle (fig. 1) .

The lamp which produces the proper quality and quantity of white light is de-signed to operate at 400 volts and 400 cy-cles. Other lamps of different colors and brightness operate at different combinations.

The electric power source is an Ever-ready battery, No. 226, nine volts, but any nine-volt battery will do. Under this load the voltage drops to eight volts and, when the battery runs down to a load voltage of 7.2 volts, the instrument ceases to operate. The cycles do not vary and the 10-percent decrease in voltage decreases the brightness by approximately five percent only just be-fore the lamp stops functioning altogether.

The size of the stimuli are varied from one mm. to 10 mm. by sliding small per-forated plastic caps with openings of one, two, three and five mm. over the 10-mm. electroluminescent disk on the end of the wand. A short wand may be used on non-projecting perimeters.

In clinical use the stimulus is best ex-posed against a flat black screen in a room which is just light enough so that the ex-aminer may observe the patient's fixation. This minimizes the visibility of the wand carrying the light stimulus, and presents the

F ig . 1 ( H a r r i n g t o n ) . T h e Lumiwand.

light source isolated against the dead black of the screen. It is a great advantage to be able to turn the light on and off by simply pressing and releasing the button on the handle. In this way the stimulus can be pre-sented, extinguished, moved, presented in a new area, extinguished, moved and pre-sented again over the entire area of the vis-ual field.

The Lumiwand has been tested and com-pared with other stimuli in a variety of con-ditions producing visual field defects, includ-ing glaucoma, optic neuritis and diseases af-fecting the visual pathway from the chiasm to the occipital lobe.

384 Post Street (8).

R E F E R E N C E S

1. Berens, C , Kern, D . , and Evans , J. : W h i t e and colored spherical test objects for use in camprimetry and perimetry. Tr . S e c t Ophth. A .M.A. , 1931, p. 407.

2. Harrington, D . O. : Perimetry with ultraviolet radiation and luminescent test objects. Arch. Ophth., 4 9 : 6 3 7 ( J u n e ) 1953.

B I N O C U L A R B A N D A G E

G A R Y J . M A S T M A N , M . D .

Sunnyvale, California

Removal of tape from surgical patients with binocular bandages is frequently irri-tating to the skin, especially in youngsters who have undergone muscle operations and in those patients allergic to tape. For this

reason, a simple head bandage was devised for patching both eyes without the use of any tape. The material used is Velcro which consists of two types of plastic strips, one having many tiny plastic hooks and the other having many, fine, soft plastic loops. When the two strips are placed together, the hooks facing the loops, there is a great re-sistance to shearing pressure ; however, they

304 N O T E S , C A S E S , I N S T R U M E N T S

Fig. 1 ( M a s t m a n ) . Mask for eyes.

can be easily separated by peeling them apart. The Velcro material can be obtained in strips of one or two inches in width and in colors of white, black and green.*

The mask (fig. 1) which goes over the front of the eyes is made of an ace bandage, two inches wide and folded five or six times. Stitches are run up and down, across the width of the ace bandage and around the edges, binding it securely. A cover is made for this folded ace bandage out of a large width of ace bandage and stitched around the edges, leaving a notch for the nose. This eye bandage is still quite elastic in spite of having the machine stitches across its width, yet it does not stretch excessively.

A strip of Velcro material, with the loops facing toward the face, is stitched to the ends of the ace bandage, overlapping it on the inside about one-half inch to give good support. The bandage is formed by placing a two-inch-wide strip of Velcro around the back of the head and over the ears (fig. 2 ) , ending at the lateral edges of the orbit. This strip has its hooks facing outward, the smooth side against the head.

Two or three 2.0 by 2.0 gauze bandages, or eyepads, are placed over the closed eyes. The ace bandage is pressed with moderate firmness over the eyes, pulled to the de-sired tautness and placed in contact with the hooks of the Velcro coming around the back of the head. Another strip of Velcro, about one inch in width, is placed across the top of the head, with the looped surface fac-ing toward the hair. This strip is placed in

* Supplied by A. S. Aloe Company.

Fig . 2 ( M a s t m a n ) . Bandage.

contact with the hooks of the strip placed around the back of the head. The one-inch strip of Velcro over the top of the head is pulled down tightly and, by doing so, the two-inch strip of Velcro is easily pulled away from the ears, thus relieving all pres-sure on the ears and allowing the patient to hear clearly.

Care must be taken not to place the band-age over the eyes too tightly. This head bandage can be adjusted to any size head by adjusting the points of contact of the Velcro or by merely snipping off a piece of excess Velcro material. The ace bandage over the eyes should be dry-cleaned but the Velcro material itself can be washed with-out any harm, and it can be used over and over again. This bandage appears to be quite comfortable and completely eliminates the need of tape on the face for a tight band-age.

Velcro is a very versatile material, and certainly can be adapted to many other types of bandages and uses. With a little redesign-ing, a bandage for one eye might be de-veloped which would be much easier and

N O T E S , C A S E S , I N S T R U M E N T S 305

E Y E L I D I N F E S T A T I O N BY ARMILLIFER A R M I L L A T U S

E. N E U M A N N , * M.D.

A N D

N. G. G R A T Z *

Monrovia, Liberia

I N T R O D U C T I O N

Armillifer armillatus (Wyman) Sambon is a member of the arthropod class Penta-stomida, or tongue worms. The larva was originally described by Prumer in the liver of man in Cairo in 1847, while the adult was discovered by Wyman in 1848 in the lung of the African Pythod (Castallani, Α., and Chalmers, A. J., 1919). Since then nymphs of this parasite have been fre-quently reported in man in various areas of Africa, including Gambia, Ivory Coast, Ghana, Cameroons, St. Helena and Senegal (Craig, C. F., and Faust, E. C , 1947), South Africa (McLean, Ε . M., 1959), Bel-gium Congo (Strong, R. P., 1944), Nigeria (Cannon, D. Α., 1942), and in Liberia (Gratama, S., and Van Thiel, 1957).

Ocular infestation with this species is rare and to the best of our knowledge has been recorded in only two cases, in which it was found in the conjunctiva. The following case report gives an account of an infesta-tion of the skin of the eyelid of a Liberian boy by A. armillatus, causing dacryostenosis.

* O n leave from the Department of Ophthalmol-ogy, Rothschild Hadassah Univers i ty Hospital , and the Hebrew Univers i ty-Hadassah Medical School, Jerusalem, Israel.

t O n leave from Vector Control Section, Ministry of Health, Jerusalem, Israel.

F ig . 1 ( N e u m a n n ) . Dorsal v i ew of Armil l i fer armillatus larva removed from the lower eyelid.

C A S E R E P O R T

A nine-year-old Afr ican boy w a s brought to the clinic of the Liberian Government E y e Hospital , Monrovia, wi th a swell ing in the lower left eyelid. T h e swell ing was said to be of about one year's du-ration and w a s apparently painless. Apart from con-tinuous tearing in the eye, there seemed to be no other discomfort.

Examinat ion showed a flaccid swell ing, two cm. in diameter at the inner canthus of the left lower lid. A t the peak of the tumor, just below the lacri-mal punctum, the skin had a yel lowish discoloration but w a s normal elsewhere. W h e n flushed, the lacri-mal passages were patent although the tumor was pressing on the lower canaliculus.

T h e skin around the tumor was infiltrated with Novocaine and, as soon as a chalazion clamp w a s placed over it, the swell ing burst through the ye l -lowish area liberating a flow of ye l low-green pus together with a grayish corkscrew-shaped worm 20 mm. in length (figs. 1 and 2 ) . T h e abscess cavity w a s scraped clean of necrotic debris. T w o days later an additional flushing of the lacrimal passages through the lower punctum filled the cavity, show-ing a connection with the lower canaliculus.

The exuded w o r m w a s identified by Prof . G. Wittenburg of the H e b r e w Univers i ty Hadassah Medical School, as a nymph of Armil l i fer armilla-tus of the class Pentastomida.

F ig . 2 ( N e u m a n n ) . Ventral view.

quicker to apply and have none of the dis-advantages of tape.

596 South Carroll.

A C K N O W L E D G M E N T

I w i sh to thank Col. Richard F ixo t t ( M C )

U . S . A . F . , for his valuable suggestions.