Complete Text (Part 4)

opacities frequently seen in the vitreous. 9. When looking in certain direc- tions, patient often complains of something * ' waving before THE EYE." 10. Appears suddenly. 11. Seen by using a strong convex or weaker concave glass than would be used to see the remainder of the fundus. Exudation of Retinitis. I. Vision impaired in certain areas of the visual field. 2. Pain none. 3. External appearance of eye nor- mal. Ophthalmoscopic appearances : 4. Optic nerve may be well defined. 5. Yellow- white stationary mass, with normal-sized blood- vessels running into or UNDER it, these blood-vessels CAN be followed DIRECTLY TO THE DISC without trouble or change of glass. 6. Veins may be full. 7. Usually more than one patch and in region of the macula. 8. Floating opacities not frequently seen in the vitreous. 9. No WAVY MOTION COMPLAINED OF. 10. Appears suddenly in most cases. 11. Seen with the same glass as the remainder of the fundus. ■ DETACHED RETINA {Continueo). 43 1 -Detached Retina. Membr&lious Opacity in Vitreous. 1, Vision impaired or lost in one 1. Vi.si on greatly impaired. section or area of Ihe visual field (scotoma J. 3. PaiD none. 2. Pain none. 3. External appearance of eye nor- ma!. Ophthalmoscopicap pe arancbs : OPHTHALMOSCOPIC APPEAR a.nceh: 4. A BLUISH WHITE UND0LAT1MG 4. A LARGE DARK GRAY, OK LIGHT MASS WITH THREAD-LIKE BLOOD GRAY MASS FLOATING (some- VESSELS CROSSING OVER IT ; times almost Stationary) IN THE these cannot be traced directly VITREOUS. BLOOD-VESSELSMAV to ihe di&c, without change of BE SEEN ON IT. glass in the ophthalmoscope. 5. When thz eve is at rest the 5, Membeane moves after the DETACHED PORTION DOES NOT EYEBALL IS FIXED OR AT REST, MOVE L-NLESS THE DETACHMENT AND SEEMS TO FLOAT BACK 6. Smallfloatingopaciticsareusnally 6. Small tloating opacities are usually seen in the vitreous. seen in the vitreous. 7, Myopia WITH choroihitis in a 7. Usually some of the changes MAJORITY OF THE CASES. or CHOROIDITIS CAN BE OB- 8. A PORTION OF FUNDUS USUALLY 8. No'^'rorTION OF THE FUNDUS SEEK DISTINCTLY. SEEN DISTINCTLY ON ACCOUNT 9. Virion about the same at all limes. g. Vision may be fairly good for a moment, then the appearance ■10, Appears suddenly. 10, Appears gradually. Trialment. 1 Recumbent position in bed. ^^^^^^ Hypodermic itijection of pilocar- ^^^^^1 pine. ^^^^^1 Bnid. ^^^fl 44 DETACHED RETINA (Continued). Complete Detachment of Retina. 1. Vision nil, with history of SUDDEN AND RAPID FAILURE OF SIGHT. 2. Pain none. By oblique light : 3. Opacity deep behind iris, and back from pupil. 4. Color : (lull yellow- white. 5. A LIGHT HELD IN ANY PART OF TIIK FIELD IS NOT SEEN. 6. Not infrequently the tension (T) is — (soft eyeball). Ripe Senile Cataract. 1. Vision gradually faiung until ONLY LARGE OBJECTS OR UGHT CAN BE SEEN. 2. Pain none. By oblique light : 3. Opacity close to iris, and in THE pupil. 4. Color: gray, gray-white, bluish- white, and very rarely dark brown. 5. A LIGHT HELD IN ANY PART OF THE FIELD IS LOCATED READILY. 6. Tension normal. NEURO-RETINITIS (Neuritis Descendens). May be confounded with PAPILLITIS. Neuro-Retinitis. 1 . Vision varies from normal, to almost or complete blindness, and usually depends on exudation or hemorrhajre in the retina. 2. Kxternal appearance of eye normal. 3. Pain none. Ophthalmoscopic appearances : 4. Optic disc MofeE pink or red THAN NORMAL. USUALLY SWOLLEN, AND NOT INFRE- QUENTLY ITS OUTLINE IS BLURRED OR EVEN OBLITERATED. Papillitis. I. Vision may be unimpaired even with disc swollen to the extent of three or four D. 2. External appearance of eye normal. 3. Pain none. Ophthalmoscopic appearances : 4. Optic disc sv^ollen, its outline ill-defined or lost. In some cases swelling of the disc may measure four orsixdioptries or even more, and be marked by patches or streaks of gray exudation and small hemor- rhages (choked disc). The exu- dation and hemorrhage may be very copious and extend even beyond the original limits of the disc. (Continued on p. 45.) NEURO-RETINITIS (Continued). 45 Retina may show marked hy- periemia with slight cedema, or, large yellow - white patches with ill - defined edges, small white or glis- tening white spots or dots OF EXUDATION, — all, or any of these, with small or large hem- orrliages in any portion of the fundus, or on the disc. 5. Retina normal except in the immediate vicinity of the DISC. ). Arteries may be small. ;. Veins usually full and tor- tuous. %. Both eyes affected in the great majority of cases. Usually associated with renal disease (albuminuria, diabetes), lead poisoning, high and continued fever, syphilitic meningitis, cerebro - spinal meningitis, etc. Tnaiment, Treat the cause. 6. Arteries always small. 7. Veins always full and tortu- ous. 8. Not infrequently only one eye affected, g. It is usually the result of intra-cranial disease, as tumors, all varieties, but most frequently syphilitic, injuries TO THE head, fracture OR abscess following, and menin- gitis. If the papillitis is monocular, it is usual to look for the trouble below the optic chiasm, and not infrequently paralysis of the third nerve or some of its branches, or of the third and fourth nerves, will assist in locat- ing the trouble : if due to a tumor of the cerebrum it will usually be located on the opposite side from the papillitis ; and if due to abscess on the same sid& Treatment, Treat the cause. T ^ ■'" • ', ^♦•-Xk?"M TTSl U"ir-lJ. — ZL - = ~>ai^ irr^- JIORDIumS. V . -»i. ; JJZ. rjrrsAL. Caovonims, scGlaccoica, ^ ■ ■■' ■ ' . ^^^^^TT^^^ > .i^ M rirtfrttr - T * \ ff I'TTC! ■ • : -♦ ^ ^..i.- Xi. V . " ': ■- ■ ■ •■Jl._. -'IT ""S ■■». ' 'cin^ i'lil j.na. izmoiLi :: :iie nerve :. AKLIlKIZi VORM-VL ^IZE OtT vUN niR^-'r'-iH >R 'rsz-KK patches >F SXUDATIOX. S. [ii early stages :he retina rs OFTEN HAZY IN THE REGION OF THE MACULA ; the granular ap- pearance is lost in many cases, g. Exudation, if in large patches, is usually DULL white and dis- tributed irregularly about, but most on temporal side of the fundus. Exudation, if in dots or MINUTK rATUIlKS, AS8UMRS A STSLLATB FORM ROUND TIIK ; TUIPY ARK l'r«UAUY ~iioa mar ' Uiiui f not be impaired izn. "oncL Lx rrrm i A uprjii Jiirr of eye nonnaL FHTHAXJfOSGD PIC APPEARANCES ; ??nc >'E&VK XOKMAL. 'y. Veins narxuL 7. Arteries normal size and run over patches of exudation, OR ATROPHY, S. In early stages the retina is APPARENTLY NORMAL EXCEPT OVER THE PATCHES. 9. Exudation in large patches, yei^ LOW, OR YELLOW-WHITE COLOR, and distributed in any part of fun- dus, but MOST RARE IN REGION OF THE MACULA. ^V\vm>»i»w v»« js 4>s> ALBUMINURIC NEURO-RETINITIS (Continued). 47 10. In later stages dull white or GLISTENING WHITE PATCHES are seen in the retina ; edges of the larger patches are not clearly DEFINED. 1 1 . no black pigment in or aroun d edge of patches. 12. Small hemorrhages may be seen in the fundus. 13. Vitreous normal. 14. Both eyes affected, 15. Albumin in urine. Treatment, Rest. Blue glasses. Constitutional treatment. 10. In LATER stages distinct white OR glistening white patches with clearly defined edges are seen. 11. Black pigmemt in and around edge of patches. 12. No hemorrhages in the fun- dus. 13. Vitreous hazy, with floating opaci- ties in some cases. 14. Not infrequently only one eye affected. 15. No albumin in URINE. 4S ALBUMINURIC RETINITIS (Continued). Albuminuric Retinitis. 1. Vision usually impaired. Ophthalmoscopic appearances: 2. Optic nerve usually more pink or red than normal, and its outlines not well defined on any side. 3. Veins may be full and tortuous. 4. Arteries normal. 5. Retina often hazy in the re- gion OF the macula. 6. White or glistening white PATCH KS distributed IN THE fundus, most FREQUENTLY SEEN IN THE REGION OF THE MACULA. 7. Pink retina seen between the patches and disc. 8. Exudation may cover blood-vessels where they pass under or through it. 9. Hemorrhages in retina not infrequent. 10. Blind spot of normal size. Opaque Nerve-Fibres. 1. Vision not impaired. Ophthalmoscopic appearances: 2. Optic nerve never red or con- gested, and that portion not covered by opaque nerve-fibres is well defined. 3. Veins normal. 4. Arteries normal. 5. Retina normal in region of the macula. 6. White patches, one or more, extending from the optic nerve into the retina. 7. No pink retina between patches and disc. 8. Opaque nerve-fibres cover some blood-vessels after they pass over edge of disc ; farther on vessels emerge into normal retina. 9. No HEMORRHAGE IN RETINA. 10. Blind spot usually enlai^ed. DIABETIC RETINITIS. 49 May be confounded with Albuminuric Retinitis, Leucocythemic Reti- nitis, Syphilitic Retinitis. Diabetic Retinitis. 1. Ophthalmoscopic appearances the same as in albuminuric retinitis. 2. Sugar in urine. 3. Retinal hemorrhages may be SEEN. Treatment, Treat the general condition. Albuminuric Retinitis. 1. Ophthalmoscopic appearances THE same as IN DIABETIC RETI- NITIS. 2. Albumin and casts in urine. 3. Retinal hemorrhages are fre- quently SEEN. Treatment. Treat the general condition. Leucocythemic Retinitis. 1. Ophthalmoscopic appearances ARE quite similar TO ALBU- minuric retinitis. 2. Fundus pale. 3. History of leucocythemia. Treatment, Treat the general condition. Syphilitic Retinitis. 1. Associated with syphilitic choroiditis. 2. Previous history of iritis, etc. 3. General syphilitic history. Treatment, Treat the general condition. • • • • • • •• • ••• ••- • • • • , • • • % " 50 PIGMENTED RETINITIS (Night Blindness), (Retinitis Pigmentosa). May be confounded with Disseminated Choroiditis. Pigmented Retinitis. 1. Sight impaired, except in direct line of vision. 2. Field contracted on all sides. 3. Unusual impairment of vision IN TWILIGHT (hemeralopia). Ophthalmoscopic appearances : 4. Blood-vessels normal in the early stages. 5. Pigment in the retina, which shows as SMALL IJLACK PATCHES WITH LARGE IRREGULAR PROCESSES ; near the periphery where they are most numerous, the pro- cesses may unite and form an imperfect network. 6. Later staj^es : vision impaired, APPARENTLY OUT OF ALL PRO- PORTION TO THE LESIONS SEEN IN THE FUNDUS. 7. Last Stage : atrophy of optic nerve with small blood-vessels. 8. Both eyes affected. g. Hereditary in many or most cases. Treatment, Not satisfactory. Strychnia has been advised. Diaseminated Choroiditis. 1. Sight usually a little impaired. 2. Field not contracted. 3. Vision not specially impaired in twilight. Ophthalmoscopic appearances : 4. Blood-vessels normal. 5. Some patches are composed entirely of black pigment, while others show a yellow- WHITE (exudation), or glisten- ing WHITE SURFACE (atrophy of the choroid) ^ with pigment IN AND AROUND THE EDGES. 6. Later stages : vision often sur- prisingly GOOD WHEN THE LESION OF fundus IS CON- SIDERED. 7. No atrophy of optic nerve ; blood- vessels of normal size. 8. Often one eye affected much more than its fellow. 9. Not hereditary. EMBOLISM OF THE CENTRAL ARTERY OF THE RETINA. 51 May be confounded with Albuminuric Retinitis. Embolism of the Cent. Artery of Retina. u Sudden and usually complete BLDUkNESS. 2. Pain none. 3. External appearance of ey^ normal. Ophthalmoscopic appearancis : 4. Disc well defined but pale, and in later stages white (atrophy), 5. Arteries very small. 6. Veins normal, or partly empty. 7. A bright red spot occupies the position of the macula, while the retina around this has a diffuse milky- WHITE APPEARANCE ; the re- maining retina being pale. 8. No ALBUMIN in the urine. Treatment, Massage of eyeball has been recom< mended if case is seen early. Albuminuric Retinitis. 1. Vision usually impaired. 2. Pain none. 3. External appearance of eye normal. Ophthalmoscopic appearances : 4. Disc pink, and its outline may be b)aired. 5. Arteries normal size. 6. Veins full, and tortuous in some cases. 7. Retina hazy in the region of the macula ; the granular appearance is lost in many cases ; in other cases dis- tinct DOTS OR spots OF EX- udation partially surround the macula. Small flame-shaped hemor- rhages MAY BE PRESENT IN SOME PORTION OF THE FUNDUS. 8. Albumin or casts may be found in the urine. 52 OPTIC NEURITIS (Papillitis). May be confounded with Neuro-Retinitis, Hypermetropia. Optic Neuritis. 1. Vision may remain perfect. 2. External appearance of eye normal. Ophthalmoscopic appearances : 3. A pink, a blurred ill-defined, or a swelled disc, marked by patches OF EXUDATION, and NOT INFRE- QUENTLY SMALL HEMORRHAGES WHICH GIVE THE WHOLE DISC A REDDISH-GRAY APPEARANCE (choked disc), 4. Arteries small or normal size. 5. Veins full and tortuous. To determine the amount of swell- ing of the disc, find the strongest convex glass or the weakest con- cave glass that the fundus can be seen with distinctly, then in the same manner determine the best glass to see the centre of the disc, the difference will be the amount of swelling in dioptries. If a marked papillitis abates, the outlines of the disc will be seen at first indistinctly (woolly discj^ and later the outlines become distinct and the disc of normal color, or the outlines may become unusually distinct, and the whole disc white or gray (atrophy). Hypermetropia with a slightly ele- vated disc (congenital), and an abnormal amount of Connective Tissue in and around the Disc. 1. Vision may be perfect vnth or with- out the aid of glasses. 2. External appearance of eye normal. Ophthalmoscopic appearances : 3. A slightly elevated dark pink, or dark red blurred disc, with WHITE lines (connective tissue), WHICH ARE SEEN IN AND AROUND THE DISC, BUT MOST DISTINCTLY BY THE SIDE OF BLOOD-VESSELS, and which may disappear in cer- tain lights. 4. Arteries normal size. 5. Veins normal. Disc and fundus may be seen with the same glass. 1 ATROPHY OF THE OPTIC NERVE. 53 1 May be confounded with Chronic Glaucoma, Tobacco Amblyopia, Physio- 1 LOGICAL Cupping, Alcohol Amblyopia. 1 Optic-Nerve Atrophy. Chronic Glaucoma. t. Viiion impaired 01 loEt. r. Vision impaired or lost. a, CoNCKNTRic contraction of a. ViSUAl. FIELD AND COLOR ZONES THE VISUAL PlEl.t), especially CONTRACTED MORE ON NASAL for colors green and red. THAM TEMPORAL SIDE. 3. Colored rings or halo never 3. Colored rings or halo may SEEN AROUND ARTIFICIAL BE SEEN around ARTIFICIAL 4. Pain none. 4. Pain little or none. 5. External appearance of eye nor- 5. Circum-comeal vessels may be en- mal. larged. 6. Pupil may not react to light 6, Plipil dilated more or less STIMULUS, AND WILL VET CON- according as disease is advancer! ; TRACT ON ACCOMMODATION it may or may not react lo light ( ArgyiURBbirlson pupil j. stimulus. . 7. Anterior chamber normal. 7. Anterior chamber usually 8. Tension normal. 8. Tension increased. . Ophthalmoscopic appearances : Ophthalmoscopic appearances : 9, Whole disc concave (saucer- g. Whole disc excavated {cup- shape). See page 73. shape). See page 73. 10. Color while, or mottled gray. ID. Color white, bluish-white, or gray. II. Blood-vessels pass FROM retina II. All blood-vessels BEND SHARP- INTO THE DISC WITHOUT MAK- LY OVER THE EDGE OFTHE DISC ; ING A SHARP BEND OR CURVE ; they may be seen indistinctly at THEY ARE USUALLY SMALL AND the bottom of the cup. and can STRAIGHT. be brought into view by using a weaker convex or stronger con- cave glass. 13. Any age. 13. Usually over 4a Triatmeni. Strychnia Anti-ayphilitic, ^^^ 54 OPAQUE NERVE FIBRES. May be confounded with Albuminuric Retinitis, Choroiditis, Post. Staphyloma. Opaque Nenre Fibres. 1. Vision normal. 2. Pain none. 3. External appearance of eye normal. Ophthalmoscopic appearances : 4. Arteries and veins normal, and not infrequently when leaving the disc they pass under a por- tion OF the white patch of opaque nerve fibres. 5. Irregular milky white or glisten- ing white patches, extending INTO THE RETINA FROM THE optic DISC AND CONTINUOUS WITH IT. 6. No PIGMENT DEPOSIT ON EDGE OF PATCHES. 7. Vitreous clear. 8. ** Blind spot " usually enlarged. Treatment. None. Choroiditis. 1. Vision usually impaired. 2. Pain none. 3. External appearance of eye normal. Ophthalmoscopic appearances : 4. Arteries and veins normal, and they pass over the white or yellow patches. 5. Yellow or shining white patches IN ANY portion OP THE FUNDUS and separated from the disc by normal pink retina. 6. Black pigment deposits on EDGE OF patches. 7. Vitreous usually hazy with some floating opacities. 8. " Blind spot " of normal size. GLIOMA. 55 May be confounded with Detached Retina, Sarcoma of Choroid, Pseudo-Glioma. Glioma. 1. Always under id years of age. 2. If glioma is large the anterior chamber will be shallow and the pupil dilated, with almost or complete loss of red retlex. 3. Tension will be increased. By oblique light : 4. A dirty yellow-gray or red- dish-gray MASS (depends on vascularity) back of the pupil. 5. Painful in later stages. 6. If glioma is recent and small (rarely seen) ophthalmoscope shows a yellow-white, stationary tumor, usually near the disc. 7. Usually small blood-vessels ANASTOMOSE FREELY OVER THE TUMOR (they may be absent). Treatment, Enucleation of eyeball. Detached Retina. 1. Rare before adult life. 2. If retina is completely detached there will be complete loss of red reflex. 3. Tension usually diminished. By oblique light. 4. A DULL yellow-white MASS back of the pupil. 5. No pain. 6. If detachment is recent and small ophthalmoscope shows a bluish- white mass, usually near the periphery. 7. Thread-like blood-vessels CROSS THE detached RETINA. Glioma of Retina. 1. Always in infancy or early childhood. 2. Retina involved in earliest STAGES. Sarcoma of Choroid. 1. Adult life. 2. Retina not involved in earliest STAGES. 56 CENTRAL CHOROIDITIS. May be confounded with Central Choroiditis. 1 . Vision impaired (perhaps for years). 2. Pain none. Ophthalmoscopic appearanxes : 3. Disc normal with well-de- fined EDGE. 4. Arteries normal size and run over the patches. 5. Veins normal size. 6. Exudation appears as a large, irregular, yellow, or yellow- white PATCH, with ill-de- fined EDGES,