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For a long time the striking clinical pic­ ture resulting from a carotid-cavernous fistula has been recognized as the manifesta­ tion of a communication between the carotid artery and the cavernous sinus. About 75 percent of the occurrences are attributable to known trauma, as was our case, and the remaining 25 percent appear to have a spontaneous origin secondary to a vascular lesion.' In Locke's cases of pulsating exophthalmos, 77 percent were traumatic in origin, and, of these, 94 percent had a carotid-cavernous fistula. Head injuries, gun­ shot wounds, and so forth, are responsible for the traumatic type;· sclerosis of the arterial wall with resultant weakness causes the spontaneous ones.

To the Editor. —During a 48-hour period, I saw two patients who had been using the new Ocuserts to control their glaucoma. They complained that while riding along expressways, they were almost involved in disastrous accidents. The Ocusert, which wandered under the upper lid, temporarily came over the cornea, while these persons were driving and blinking. One of them almost crashed into another car when he could not see temporarily. I think this complication of the use of Ocuserts is worth bringing to the attention of our ophthalmologic colleagues.