Complete Text (Part 1)

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About Google Book Search Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web at |http : //books . google . com/| Ik^B^Ml@ tian i^'rancisco County- Medical Society lL_^ X. DIAGNOSIS DIFFERENTIAL DIAGNOSIS AND TREATMENT OF DISEASES OF THE EYE HY A. E. ADAMS, M.D. Instructor in Diseases of the Eye in the Post-Graduate Medical College ; Assistant Surgeon to Manhattan Eye and Ear Hospital, New York ; Ophthalmic Surgeon to St. Luke's Hospital, and Consulting Ophthalmologist to the Home of the Friendless, Newburgh ; Fellow of the New York Academy of Medicine Member of the Orange County Medical Society, etc., etc. • • • • • • • • • • • • ••• ••» • • • • • •• •• m f • • m • • • • • • •' • • • • • G. P. PUTNAM^S SONS .\ NEW YORK 27 WEST TWKNTV-THIRD STRBBT LONDON 24 BKDFORO STRBBT, STKANP 3i^e $mchcTbocher ^rcss 1894 PREFACE Mv esperience with diseases of the eye, while in general practice, and the tedious task uf sifting out of the lai^ec lext-buoks tlie diagiioiilic symptoms ol the different eye diseases, have contributed or led to the compiling of these tables. They are designed more especially for the active practitioner, who does not claim to be an ophlhahnologisl, or even well posted on diseases of the eye. Under each disease or condition given will be found the different diseases or conditions with which it is liable to be confounded. Occasionally different varieties of a disease may blend so Ibat a differential. diagnosis would be impos- sible, as neither type could be excluded. Not infrequently two diseases are associated. Usually the symptoms of a disease are all given in its iiist table, but are not all given in the following tables ; they are given with special reference to making the differential diagnosis of the disease found in the opposite column : in other words, tbe symptoms are given as they are liable to occur when two diseases would be confounded. The diagnostic symptoms being in small capitals are seen at a glance. Technical terms could not be altogether discarded, as many of them are in general use : as a rule they are all given, but have been relegated fo a secondary I am fully aware of the fact, that the nomenclature can be criticised, but I have tried to keep in mind the original idea, — simplicity. The treaOnent given is not always the latest fads, but what is considered the most reliable. For the technique of operations, I would refer the reader to some of the most complete works on ophthalmology. A. E. A. Newburch, N. Y. August, 1B94. <>'^4i3 DIFFERENTIAL DIAGNOSIS OF DISKASES OF | THE EVE. Dilatation of Pupil. CoatractioQ of Pupil. (Mydriasis) (Myosis). Mydriasis may be due to: MvosTS may be due to : I, Ingestion of certain drugs, bella- 1. Ingestion of cettaio drugs, as donna, ergot, etc opium, alcohol. 2. Convergence and accommudaliun. sphincler iridb. 3, tntni-ocular pressure. 3. Evacuation of the aqueous. 4. Complete atrophy of Ihe optic 4. Irritation of retina by light. 5. Paralysis of the third nerve. 5. Irritation of brain and meninges. 6. Apoplexia in the later stages. 6. Apoplexia in early stages. 7. Irritation of the cervical meninges 7. Injuries, pressure or degeneration OT posterior columns of the curd. of the post, col, of the spinal cord (cervical portion). B. Irritation of the cervical sympa- 8. Paralysis of cervical sympalhelic. thetic. q. Anemia (rare). 9. Plethora (rare). 10. Reflex intestinal jrritalion. 10. Irritation of tbe cornea. II. Reflex uterine irritation. ji. Irritation of the iris. la. Acute mania. 12. Hysterical or epileptic convulsion (earl, stage). 13. Mekncholia. 13. Nicotine in tobacco amblyopia. 14, rrogrcssiveparalysisoflheinsane. 14. Long-continued accommodation. Drugs which canseMVDRiATrc ACTION DRtfGs which cause myotic action ifinstiUedineye: if instilled in eye: Hyoscine. Gelseroine. Eserine, Atropine. Homatropine. Physosttgmine. Duboisine. Cocaine. Pilocarpine. ^^^^^latorine. Scopolamine. Muscarine. ,^|^^^^ CONJUNCTIVITIS. May be confounded with Iritis, Sub-acute Glaucoma. Simple Catarrhal Conjunctivitis (Catarrhal Ophthalmia). 1. Lids may or may not swell. 2. A dread or intolerance of light (photophobia)^ in some cases. 3. Lachrymation often profuse, may be slight in mild or chronic cases. 4. Sensation of itching or burning, or as of a foreign body in eye. 5. Discharge sticky (catarrhal) and usually mixed with a quan- tity of tears. 6. Ocular conjunctiva injected, its vascular network is more prom- inent, while the palpebral con- junctiva is red and thickened, and at times has the ** velvety appearance." There is usually moderate oedema of the conjunctiva (chemosis) in all cases, while in some the oedema may be considerable and the injection slight. 7. Lids stick together in the MORNING. 8. Cornea not affected. Purulent Conjunctivitis (Blennorrhoea). 1. Swelling of lids. 2. Photophobia considerable. 3. Lachrymation usually consider- able. 4. Pain lancinating, especially if the cornea is involved. 5. Discharge purulent, and usu- ally profuse. 6. Ocular and palpebral conjunctiva red, with marked oedema in most cases. 7. Lids bathed in pus. 8. Cornea often involved. (Continued on p. 3.) CONJUNCTIVITIS (Continued), 9. Frequently epidemic, and may be contagious ; sometimes sec- ondary, or TRAUMATIC. 10. Usually both eyes are affected. One eye may be attacked first. 11. May terminate in a chronic con- dition (chronic conjunctivitis). Treatment, Cleanliness. Ac. boric sol. (gr. xii.- J i.) 9. Always contagious with some KNOWN cause, as IN OPHTHAL- MIA NEONATORUM, GONOR- RH(EAL CONJUNCTIVITIS, and DIPHTHERITIC OR CROUPOUS CONJUNCTIVITIS. If the case is of a diphtheritic or croupous nature, then the conjunctiva throws out, not a purulent and copious secretion, but a fibrin- ous exudation, and forms a ** false membrane." There will be a scanty purulent secretion covering the mem- brane. 10. Attacks one eye first. 11. May terminate in ulcer of cornea and loss of vision. Treatment. Cleanse thoroughly with ac. boric sol. (gr. XV.- 1 i.) and repeat as often as pus accumulates in the cul-de-sac. Ice cloths on lids. Atropine (gr. iv.- J i.) if cornea is involved. Ag. nit. (gr. x.- 5 i.)- Cover the unaffected eye with a glass shield to protect it from con- tagion. .-r.,^ ^^^H GRANULAR 5 B (Trachoma), (Granular Conjure ivi is). (Granular Ophthalmia). T N on- Vascular Granules. 1. I,ids no( apparently thickened. ' Lids slightly thickened, look puffy. s. I'holophobm little if any. - A dread or intolerance of light ( pholopkabia). 3. Pain none. 3 Pain is often considerable. 4. Secretion sticky but scanty. ■* Secretion sticky and quite copious. 5. Palpebral conjunctiva pale yellow, 5 Palpebral conjunctiva red, *■ vel- or pale pink. 6, Elevations on the Conjunctiva are 6 Elevalions on conjunctiva have the"jflfo^rti»"graoules; they s fleshy look, they may be are gray-white and semi-trans- isolated and look like granula- parent bodies about the size ol a tion tissue, or they may be small brass pin head and par- grouped in a cluster giving the tially embedded in the pale " velvety appearance." This conjunctiva. may be so marked that when the lid is everted there are ap- parently fissures along the edge of the tarsal cartilage. 7. Ocular conjunctiva nearly normal 7 Ocular conjunctiva usually con- tains enlarged, dark-colored, and tortuous blood-vessels, andif the case is of long standing these vessels extend down on the cornea and is termed /niwwj. I 8. Cornea usually clear. B In old cases cornea may be found ulcerating, or if the ulcers have healed, then opacities will re- kL p.6,) GRANULAR LIDS (Continued). 9. An acute or active condition may be engrafted on the non-vascu- lar or chronic state and convert it into the vascular form. Treatment, Squeeze out the granules with tracho- ma forceps ; or pick out with a sharp pointed instrument. 9. New connective tissue is found in the palpebral conjunctiva ; this eventually contracts and leaves scar tissue which rubs on the cornea causing irritation and blepharospasm and sometimes entropion. Treatment, Glycerite of tannin applied direct to granulations. Cupri sulph. locally to granules. Squeeze the granulations with tracho- ma forceps. Grattage. ^^^^^^^^^ 7 ^M May be confounded with Vahcitlar Keratitis. ^H Pterygium. Vascular Keratitis. 1 1. Duration years. 2. Vision normal, or at leaal good. J. Pain none. 4. Bright light does not, but cold winds may cause a little irrita- tion of eyes. 5. Palpebralconjunctivanormal. 1. Duration months. 2. Vision poor. 3. Pain may or may not be severe. 4. Bright light causes irritation and lachrymal ion of the eyes. 5. Palpebral conjunctiva usually 6. Blood-vessels in conjunctiva are fine and straight, and with con- nective tissue forms A triangu- 6, Blood-vessels are large, dark- APEX RESTING ON THE COKNBA. Tr/a/m/nt. Not infrequently ulcerative kera- titis complicates. Amyloid Degeneration of the Con- junctiva. Sarcoma of the Conjunctiva. I- Light yelJow mass or masses usually in the palbebral con- junctiva. a. Slow development. None. Ecchymosis of the Conjunctiva. 1. May be either a while or pigmented growth, and frequently returns after removal. 2. Rapid development. Treatmitnl. Operation (or the complete removal of the tumor. Xerosis. 1. Extravasaled blood between the conjunctiva and sclera. I. Conjuni^liva is apparently dry, and has lost much of its usual lustre. Trinlmrnt. None. Tv^atmenl. No known cure. 8 SCLERITIS. May be confounded with Episcleritis. Scleritis. I. A GENERAL CONGESTION OF THE MORE SUPERFICIAL VESSELS OF THE SCLERA or portions of it. 2. A semi-chronic inflammation which rarely develops into an acute trouble. 3. Little or no elevation. Episcleritis. 1. Localized swelling or inflam- mation OF the episcleral TISSUE which soon affects the sclera proper. 2. Color dark red or pink ; the old patches have a purple or lead color. 3. Conjunctiva and sub-conjunctival tissues are thickened which makes the patch somewhat ELEVATED. Treatment. Mixed treatment. Rest. EPISCLERITIS. May be confounded with Scleritis, I Episcleritis. 1. Light does not irritate the eye. 2. Pain none. 3. Secretion none. 4. Circumscribed congestion of a SLIGHTLY elevated PATCH OF conjunctiva and episcleral TISSUE. 5. No tendency to suppurate. RiTis, Phlyctenular Conjunctivitis. Phlyctenular Conjunctivitis. 1. Light may irritate the eye. 2. Sensation, burning or itching. 3. Secretion sticky (slight). 4. Yellow gray elevation on a reddened patch of conjunc- tiva. 5. Tendency to form a minute ab- scess on elevation ; this ruptures and a small ulcer results 6. Chronic disease. Treatment. Anti gouty. Mixed treatment, salicylate of soda, tonics, atropine, rest. (phlyctenular ulcer). 6. Acute disease. ABRASION OF THE CORNEA. May be confounded with Abscess of the Cornea, Phlyctenular Keratitis. I. 2. Abrasion of the Cornea. Pain usually severe. A dread or intolerance of light ( photophobia) ^ with profuse flow of tears (lachrymaiion)^ and there may be spasm of the orbicularis muscle (blepharo- spasm), 3. Whole conjunctiva may be con- gested. 4. Corneal haziness due to loss OF CORNEAL EPITHELIUM (super- ficial). 5. Corneal opacity due to suppura- tion and pus on the corneal abrasion ; yellow-gray color. 6. Abrasion clean-cut, circum- SCR4BED. 7. Corneal surface not smooth, and in the abrasion the lustre is lost. 8. No iritis. 9. No complications in early stages. 10. History of traumatism. rest with eye lightly Treatment, Absolute bandaged. Atropine (gr. ii.- § i.) q. 4 h. Oils (olive or castor) instilled freely. Cocaine may be instilled to relieve severe pain. Abscess of the Cornea. 1. Pain moderate, or none at all. 2. Light usually fairly well borne with little or no lachrymation and no blepharospasm. 3. Circum-comeal injection, may be little or none. 4. Corneal haziness due to in- filtration BETWEEN the layers of the cornea (deep). 5. Corneal opacity due to pus be- tween the layers of the cornea ; yellow-gray color. 6. Edges of abscess not so we;ll defined. 7. Corneal surface smooth ; lustre may be lost over the abscess. 8. Iritis often complicates. 9. Hypopyon, ulcer of cornea, cyclitis, etc., may complicate. 10. May be the result OF trauma- tism. lo PHLYCTENULAR KERATITIS. May be confounded with Abrasion of Cornea, Interstitial Keratitis, Opacity of the Cornea. Phlyctenular Keratitis. 1 . Vision may be but little impaired. 2. Pain always severe. 3. A dread or intolerance of light (photophobia)^ with profu-se flow of tears (lachrymation)^ and spasm of the orbicularis muscle (blepharospasm), 4. Phlyctenular conjunctivitis fre- quently associated. 5. Corneal opacity elevated. 6. Corneal opacity gray, or yellow- gray. 7. Corneal opacity always small and oval. 8. No history of traumatism. 9. Duration may be days. 10. Children's disease. 11. Terminates in loss of substance (minute ulcer), which may or may not leave a permanent opacity of the cornea. One, two or three blood-vessels may extend to the * * phlyctenular ulcer" (fascicular keratitis). Treatment. Attention to hygiene and diet, especially diet. Treat any nasal catarrh present. Locally : Ac. boric, sol. (gr. xii- 5 i-)« Atropine (gr. ii.- § i.). Ung. hg. ox. fla. (gr. xii.- J i.). Abrasion of the Cornea. 1. Vision may be but little impaired. 2. Pain always severe. 3. Photophobia, lachrymation, and blepharospasm, all in a marked degree. 4. Conjunctival injection. 5. Corneal opacity depressed. 6. Irregular opacity gray and lustre- less from loss of epithelium. 7. Corneal opacity any size, long, or irregular. 8. History of recent trauma- tism. 9. Duration usually hours. TO. Any age. II. Terminates in epithelium being rapidly restored ; or the forma- tion of pus and ulceration on the site of the abrasion. PHLYCTENULAR KERATITIS (Cof Phlyctenular Keratitis. Opacity of the Cornea. I. Vision may he but little impaired, I. Virion depends on siie anJ loca- depends on site of phlyctenule. tion of the opacity. 2. Paiv always severe. 2. Pain none. LIGHT WITH PROFUSF FI OW OF 3. Light does not affect thf. 4. Phljctenulai: conjunctivitis fre- 4. No conjunctivitis. quently associated. 5. Corneal OP AciTv ELEVATED. S. Corneal opacity smooth. 6. Corneal opacity yellow or gray. 6. Corneal opacity gray or white. 7. Corneal opacities always small. 7. Corneal opacities may be any 8. Blood-vessels may extend to 8, No blood-vessels on or in the phljcteoule in later stE^es, or. cornea. after it ruptures and becomes a small nicer. 9. Duration few Jays. 9. Duration weeks or months. ^^^ 10. Disease of chiHreo. to. Any age. ^H Herpes of the Cornea. Keratitis Bullosa. ^H I. Rare. 1. Rare. 2. Usually adults. 2. Usually adults. 3. Associateii with herpes of the 3. Associated withsomedeep inllam- face. malion. 4. Ulceration deeper than phiycten- 4. Appears as blebs large or small. uitu ulceration. and may terminate In ulceration. Conical Cornea (Keraio-con us). Hydrophthalmia (Kerato-globus) (Buphthilmus). r. Not infrequent. I. Rare. a. Acquired. 2. ConEenilal (usually). 3. Viewed transversely cornea alone 3. Whole cornea and adjacent sclerot- is seen to be conical. ic is bulging. 4. Ant. chamber deep. 4. Ant. chamber deep. 5. Itis normal. S. Iris tremulous. 6. Vision poor. 6. Vision very poor. 7. Cornea clear. 7. Cornea clear, transparent. 13 ABSCESS OF THE CORNEA. May be confounded with Abrasion of the Cornea, Ulcer of the Cornea, Opacity of the Cornea, Interstitial Keratitis, Hypopyon. Abscess of the Cornea. 1 . Vision may or may not be impaired. 2. Pain not usually severe ; may be absent. 3. Bright light is liable to irritate