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hoi have been used to treat eyes in which the pain was secondary to corneal ulcers, keratitis, uveitis, and glaucoma.4"6 Our injection technique, which uses a 3.5-cm 22-gauge rejrobulbar needle, is similar to those used by others. 1A4 ' 6 The patient is placed in the prone position and may be given an oral analgesic before the injec tion. The first injection is a short-acting anesthetic such as 2% lidocaine HC1 and contains 30 units of hyaluronidase per milliliter with epinephrine added at the discretion of the surgeon. The injection volume is 3 ml, with 2 ml given in the anterior retrobulbar space and the re maining 1 ml injected as the needle is removed from the tract. We assure the patient that the second injection will cause little if any pain. We wait at least 15 minutes before injecting the alcohol. By that time the patient has begun to feel the effect of the local anes thesia and is generally quite relaxed. A 1or 2-ml retrobulbar injection of 95% ethyl alcohol is given by inserting the needle through the previous tract. Except in rare instances, the patient feels no more than a mild sensation of pressure during the reinsertion of the needle and the retro bulbar injection of alcohol. D O N A L D R. MAY, M.D. W I L L I A M N. MAY, B.S.
REFERENCES 1. Maumenee, A. E.: Retrobulbar alcohol injec tions. Relief of ocular pain in eyes with and without vision. Am. J. Ophthalmol. 32:1502, 1949. 2. Grüter, W.: Orbital injection of alcohol for relief of pain in blind eyes. Ber. Versammlung Oph thalmol. Ges. 1918, p. 85. 3. : Review of experiences with interorbital alcohol injections according to Grüter. Arch. Ophthalmol. 144:92, 1941. 4. Weekers, L. : Treatment of painful diseases with persistent vision by orbital injection of weak solutions of alcohol. Arch. Ophthalmol. 47:299, 1930. 5. : Treatment of afflictions of the eye by means of orbital injections of alcohol. Ann. Ocul. 176:81, 1939. 6. Magitot, A. : Intra-orbital injections of alcohol. Ann. Ocul. 180:107, 1947.
BOOK REVIEWS Ocular Anatomy, Embryology, and Tera tology. Edited by Frederick A. Jakobiec. Philadelphia, J. B. Lippincott Co., 1982. Hardcover, 1,200 pages, index, approximately 1,000 black and white figures. $125 This volume is the hardcover version of the first volume in the looseleaf series, Biomedicai Foundations of Ophthalmolo gy, Anatomy, Embryology, and Teratolo gy, for which Dr. Jakobiec is the Section Editor. The advantage of obtaining this book over the more extensive three-volume looseleaf publication is reduced initial cost, although the looseleaf publication has the advantage of future revision, which this book does not have. The current text is a compilation of chapters by 38 contributors, all of whom are trained anatomists, ophthalmic pathologists, or clinical ophthalmologists trained in subspecialty areas. The initial chapter of the book gives a summary of the general topographic anatomy of the eye, providing the reader with the basic facts necessary for understanding the other chapters in the book. The ensuing chapters then develop the theme of pre natal development of the eye and its adnexa, and include a superb chapter on neural crest and mesodermal interac tions. This chapter, together with the following chapter, "Cell action and cell interaction during ocular morphogene sis," are impressive contributions by embryologists who clarify the role of the neural crest in the derivation of the ocu lar and periocular supporting tissues. As indicated by the Editor, these chapters are the first major update on ocular em bryology since the classic treatise of Ida Mann. The book is extensively illustrated, but the clarity of the illustrations varies from
AMERICAN JOURNAL OF OPHTHALMOLOGY
contributor to contributor. The section on cornea is well written, but the illustra tions in general do not show enough detail to illustrate the points being made. This is particularly true of the clinical photographs and the histopathologic specimens. Conversely, the chapter on "Functional anatomy of the anterior chamber angle" has excellent electron microscopic and diagrammatic illustra tions of the anatomy of the chamber an gle. The chapters on the iris, ciliary body, zonular apparatus, and lens adequately describe the structures, pulling together information from diverse sources about the developmental anatomy and, to some degree, functional pathology, particular ly in age-related processes. Clinical anatomy of the vitreous is com prehensively covered in a beautifully il lustrated chapter. The subsequent chap ter on "Functional anatomy of the vitreous" presents, by comparison, a rather superficial description. The cited references tend to be largely from early reports. The embryogenesis and structural anatomy of the retina is covered ade quately. The chapter on "Functional anat omy of the retina" provides a well written and well illustrated description of cellular biology and membrane physiology. Simi larly, "The topographic and structural morphology of the retinal pigment epi thelium" is lucidly written, although it draws heavily from the previous publica tion of its two authors. The chapters on the choroid, sclera, and the optic nerve and its axonal trans port are clearly written. The final third of the volume concerns the "Anatomy of extraocular movements," the "Visual sen sory system," "Computed tomography of the orbit and brain," and "Eye move ments." The chapter on eye movements is of great value to the clinician who desires a summary description of ocular movement disorders and variants of nor mal. Although more than 100 pages are given to "Ocular teratology," most of the
topics are so superficially covered that it represents a mere listing of abnormali ties. The volume represents a splendid com pendium of works by careful contribu tors. The book will be a valuable asset to the student of ocular anatomy, presenting the subjects with extensive visual aids. I certainly recommend it highly. THOMAS M. AABERG
Dacriologica Basica. By Juan Murube Del Castillo. Madrid, Institute de Cooperacion Iberoamericana, 1982. Hard cover, 968 pages, subject index, author index, 101 color figures, 342 black and white figures. Dr. Murube presented this treatise as the official theme of the 1981 meeting of the Spanish Ophthalmological Society. His book is the labor of several years and is a monumental contribution to this area of ophthalmology. Basic Dacriology deals with everything pertaining to the lacrimai system except surgical techniques. The text is divided into five chapters. The chapters on anatomy and embryology are comprehensive, with excellent origi nal histologie illustrations. The many color plates present different stages in the development of the lacrimai system in detail. Probably the most complete chap ter is the one on the physiology of the various components of the lacrimai sys tem. The author has thoroughly reviewed all the publications in this area and de scribes the clinical tests performed in lacrimai dysfunction syndromes. I would have liked to see more of Dr. Murube's personal opinions and comments, partic ularly in the chapter dedicated to clinical semeiology. Every chapter is preceded by a historical review and contains a detailed reference list. The book also includes a large dacriologic dictionary, which is of both practical and historical interest. This book would be a welcome