The object of this paper is to draw attention to the fact that asymmetrical opacities of the optical media, especially of the posterior layers of the crystalline lens, may cause asymmetrical defects in the visual field, and that such defects vary with the diameter of the pupil. Opacities situated in the posterior layers of the lens cause a defect in the visual filed on the opposite side, while opacities in the cornea cause a defect in the visual field on the same side. The optics of these two situations are explained in simplified diagrams below in Figs i and 2.

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SUMMARY A series of 59 patients were examined for loss of corneal sensitivity. Thirty-five of them suffered from scleritis and 24 suffered from episcleritis. There was a difference between the 2 conditions in that significantly more patients with scleritis were affected than patients with episcleritis. It was also found that among the scleritis patients there was a close relationship between the number of quadrants affected and decrease in sensitivity. Five patients had necrotising scleritis, and they all showed marked loss of sensitivity. Sensitivity returned to normal when the scleritis resolved except when a large area of scleral ectasia resulted.The test is of importance because it is one of the easiest methods of detecting the onset of necrotising scleritis in its earliest stages.

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From the Departments of Rheumatism Research and Cardiology, Manchester Royal Infirmary, and the Manchester Royal Eye HospitalScleritis is known to occur as a manifestation of connective tissue disease, particularly rheumatoid arthritis and polyarteritis nodosa (Manschot, 1961).In a recent study of 31 patients with scleritis (Lyne and Pitkeathly, 1968), evidence of connective tissue disease was found in fourteen (45 per cent.). Since this study was completed, we have encountered a further three patients presenting with scleritis in whom aortic incompetence was found. Two had severe aortic regurgitation and complete atrioventricular (AV) block. The third had a diffuse arteritis, and the aortic incompetence was only a minor feature of this illness.Case reports Case 1, a 56-year-old housewife, gave a 5-year history of almost continuous inflammation affecting the left eye with severe pain at times. The right eye had never been involved. For 2 years she had complained of breathlessness, weakness, tiredness, and light-headedness on exertion. During the previous few months, she had experienced episodes of dizziness and had lost consciousness on several occasions. Examination The abnormalities were confined to the left eye and the cardiovascular system.The perilimbal sclera of the left eye showed diffuse thinning for about 2 mm. all round. The sclera elsewhere was thickened by a subconjunctival granulomatous-like infiltration. A fairly severe uveitis was present. There was elevation of the retina on the temporal side subjacent to the site of the most intense inflammation.The pulse was regular, collapsing in type, and the rate 38/min. The blood pressure was 220/40 mm. Hg. A hyperdynamic left ventricular impulse was palpable. There was a short aortic ejection systolic murmur and a moderately long aortic diastolic murmur. The aortic second sound was diminished.