Complete Text (Part 5)

AND OCCASIONAL- ly pigment in or around it. 7. White patches with well- defined EDGES, AND PIGMENT IN OR AROUND THEM, DENOTE atrophy of the choroid AND exposure of the sclerotic. 8. Floating opacities in the vitreous. 9. No hemorrhage seen in the FUNDUS. ID. No ALBUMIN IN URINE. Treatment, Rest. Atropine. Colored glasses. Constitutional treatment. Albuminuric Retinitis. Albuminuric Retinitis. 1. Vision impaired (recent). 2. Pain none. Ophthalmoscopic appearances : 3. Disc usually more pink or RED than NORMAL AND ITS outline not well defined. 4. Arteries normal size and run through or under the PATCHES. 5. Veins more or less full and tortuous WHEN DISC IS NOT WELL DEFINED. 6. Exudation appears as a dull- white OR WHITE PATCH WITH ILL-DEFINED EDGES AND NO PIGMENT. 7. White patches are small, usually glistening, and most abundant in region of the MACULA. No pigment in or around them. 8. no floating opacities in the vitreous. 9. Hemorrhages frequently seen IN THE fundus. 10. Albumin and casts in urine. DISSEMINATED CHOROIDITIS. 57 May be confounded with Albuminuric Retinitis, Pigmentary Retinitis, Tubercle of the Choroid. Disseminated Choroiditis. 1. Not uncommon. 2. Vision may not be impaired. 3. Pain none. 4. External appearance of eye normal. Ophthalmoscopic appearances : 5. Arteries and veins normal and run over the patches. 6. Exudation in circumscribed yel- low, or yellow-white patches, with ill-defined edges, and of irregular size and shape. There may be one or many patches. As the exudation disappears the atrophied choroid allows the glistening scle- rotic TO BE SEEN ; CHOROIDAL pigment usually ADHERES TO the edges. 7. Size of patches 3 mm. or more. 8. Small opacities in vitreous are not infrequent. 9. No tubercle. Treaimefit, Rest. Colored glasses. Mixed treatment. Tubercle of the Choroid. 1. Very RARE. 2. Vision not impaired. 3. Pain none. 4. External appearance of eye normal. Ophthalmoscopic appearances : 5. Arteries and veins normal. 6. Distinct, small, yellow-white oval bodies, which are slightly elevated. The number is usually small. May be confined to one large mass in region of the disc or macula. A majority of the cases are seen in children. 7. Size of tubercle 3 mm. or less. 8. No opacities in the vitreous. 9. Tubercle of lungs or meninges. 58 TUBERCLE OF THE CHOROID. May be confounded with Disseminated Choroiditis, Albuminuric Retinitis. Tubercle of the Choroid. 1. Rare. 2. Vision not impaired. 3. Pain none. Ophthalmoscopic appearances 4. Disc normal. 5. Arteries normal ; and are never covered by tubercle. 6. Retina not hazy. 7. Small, elevated, yellow-white bodies in retina. 8. Form regular, and circular, OR oval. 9. Size, 3 mm. or less in diam. 10. Distributed as single points in the fundus. 11. No hemorrhage in fundus. 12. Tubercle of lungs or men- inges. 13. No albumin in urine. Treatment, Treat the general condition. Albuminuric Retinitis. 1. Not infrequent. 2. Vision usually impaired. 3. Pain none. Ophthalmoscopic appearances : 4. Disc more pink or red than normal, and often its outline is blurred. 5. Arteries normal and run THROUGH PATCHES OF EXUDA- TION. 6. Retina often hazy in region OF THE macula. 7. Large yellow-white, or small glistening white patches in the retina ; not elevated. 8. Form irregular. 9. Size, always some patches more than 3 mm. in diam. ID. Small patches or dots USUALLY grouped IN A STEL- LATE FORM round the macula. It. Hemorrhage frequent in fundus. 12. No tubercle of lungs OR meninges. 13. Albumin in urine. CARCINOMA OF THE CHOROID. 59 May be confounded with Detached Retina, Glioma. Sarcoma of the Choroid. 1. Rare. 2. Vision not usually impaired in the earliest stages. 3. Vision impaired gradually. 4. External appearance of eye normal. Ophthalmoscopic appearances : 5. Circumscribed oval or round elevation under the retina^ 6. Color dark gray, or decidedly pigmented. 7. Blood-vessels of irregular course, ribbon-like appear- ance, AND DARK ORANGE COLOR (choroidal vessels), anastomose FREELY OVER THE TUMOR. Later stages : 8. Pain. 9. Swelling of conjunctiva and LIDS. 10. Tension increased. 11. Pupil dilated. 12. Ant. chamber shallow. 13. Retina completely detached. Treatment, Enucleation. Detached Retina. 1. Common. 2. Vision impaired in some portion of the field. 3. Vision impaired suddenly. 4. External appearance of eye normal. Ophthalmoscopic appearances : 5. An irregular wavy or undu- lating mass. 6. Color bluish-white. 7. Blood-vessels pass almost straight across the mass AND are apparently VERY SMALL AS COMPARED WITH HEALTHY RETINAL VESSELS. Later stages : 8. No PAIN. 9. Lids do not swell. 10. Tension diminished. 11. Pupil normal. 12. Ant. chamber normal. 13. Retina completely detached. 6o ALCOHOL OR TOBACCO AMBLYOPIA (Amaurosis). (Retro-Bulbar Neuritis), (Amblyopia ex abusu). May be confounded with Optic-Nerve Atrophy, Chronic Glaucoma. Alcohol or Tobacco Amblyopia. 1. Vision gradually impaired. 2. External appearance of eye normal. 3. Visual field not usually con- tracted TO ANY considerable extent, but by careful examination with the peri- meter, scotomata for green and red will be found (field of retro-bulbar neuritis). Ophthalmoscopic appearances : 4. Disc normal except the tem- poral third, which is a little pale, or gray. 5. Arteries normal size. C. Retina normal pink color. 7. Excess of alcohol or tobacco, or usually both. Amblyopia may be caused by : a. Hysteria. b. Quinine. c. Salicylic acid. d. Exposure to bright light. e. Lightning stroke. f. Glycosuria. Treatment, Remove the cause. Strychnia. Optic-Nenre Atrophy. 1. Vision gradually impaired. 2. External appearance of eye normal. 3. Concentric contraction of the visual field, especially for colors green and red. No scotomata. Ophthalmoscopic appearances : 4. Whole disc pale or white, SOMETIMES gray, and usually a little excavated (saucer-shape) ; may be mottled. 5. Arteries small. 6. Retina pale, 7. No EXCESS OF alcohol OR TO- BACCO. PHYSIOLOGICAL CUPPING OF THE OPTIC DISC. 6i May be confounded with Chr. Glaucoma, Atrophy of the Optic Nerve. Physiological Cupping of Disc. 1. Vision not impaired. 2. Visual field normal. 3. Pain none. 4. External appearance of eye normal. Ophthalmoscopic appearances (see page 72). 5. Fundus normal color. Treatment. None. Optic-Nenre Atrophy. 1. Vision impaired. 2. Visual field contracted, espe- cially FOR colors. 3. Pain none. 4. External appearance of eye normal. Ophthalmoscopic appearances (see page 72). 5. Fundus pale. Megalopsia. 1. Objects appear to be too large. 2. Due to retinal changes which can- not be detected with the oph- thalmoscope. Treatment, None. Micropsia. 1. Objects appear to be too small. 2. Due to retinal changes which can- not be detected with the oph- thalmoscope. Treatment, None. Metamorphopsia. I. Objects appear to be distorted. 2.Due to retinal changes, or astig- matism. TrecUment. Correct any astigmatism. See de- tached retina. Photopsia (Phosphenes). 1. Flashes of light or sparks before the eyes. 2. Due to retinal changes. Treatment, Treat the cause, it may be found in the retina, or choroid. Attention to the general health. 62 ACUTE GLAUCOMA. May be confounded with Iritis, IifTSiSEiTiAL Keratitis, Irido-Cycutis. Acute Glaucoma. 1. Vision failing rapidly, especially on the nasal side of field. 2. Pain severe, extending to temple and side of the hea4, often caus- ing nausea. 3. Some dread and intolerance OF LIGHT (photophobia), 4. Colored rings or halo round artificial LIGHTS. 5. Tension increased to a marked degree (T. + 2). 6. (Edema of lids and conjunctiva. 7. Circum-corneal injection. 8. Cornea loses some of its lustre, and there may be partial anaesthesia. 9. Anterior chamber shallow. ID. Aqueous turbid. 11. Pupil dilated, sluggish, and often has a greenish hue. 12. Iris somewhat discolored. 13. No exudation in pupil. 14. No POSTERIOR SYNECHIiE. Ophthalmoscopic appearances (see page 72). 15. Often impossible to see fundus. 16. Field contracted on nasal SIDE, and occasionally above and below, while the temporal side may remain unaffected. 17. Age over 35. Treatment, Salicylic acid. Cathartics. Eserine gr. i.- J i. instilled into eye. Iridectomy or sclerotomy. Iritis. 1. Vision impaired. 2. Pain severe, extending to nose, brow, and temple. 3. Marked photophobia, 4. no colored rings or halo round artificial lights. 5. Tension may be slightly in- creased (T. + ). 6. Gildema of lids and conjunctiva. 7. Circum-corneal injection. 8. Cornea clear, with no anaesthesia, but appears to be hypersensitive. q. Anterior chamber normal. 10. Aqueous ** muddy." 11. Pupil contracted, and slug- gish OR STATIONARY. 12. Iris discolored. 13. Exudation in pupil. 14. Posterior SYNECHiiE, Ophthalmoscopic appearances : 15. Exudation usually obstructs a good view of fundus. 16. Field not contracted. 17, Rare before puberty. ACUTE GLAUCOMA (Continued). 63 Acnte Glancoma. 1. Vision on nasal side of field, fail- ing or lost. 2. Pain severe, extending to temple and side of the head. 3. Some dread and intolerance of light. 4. Colored rings or halo round artificial lights. 5. Tension increased to a marked degree. 6. CEdema of lids and conjunctiva. 7. Circum-corneal injection. 8. Cornea loses some of its lustre, and THERE MAY BE PARTIAL OR COMPLETE ANiESTHESIA. 9. No BLOOD-VESSELS ON CORNEA. 10. Ant. CHAMBER SHALLOW. 11. Pupil dilated, sluggish, and OFTEN HAS A GREENISH HUE. 12. Failure of accommodation. 13. Visual field contracted, especially on nasal side. Ophthalmoscopic appearances (see page 72). 14. Often impossible to see fundus. 15. Rarely under 35. 16. No hereditary syphilis. 17. Teeth regular. Interstitial Keratitis. 1. Vision impaired over most of the field. 2. Pain severe as cornea is involved ; referred to eyeball. 3. A dread and intolerance of light. 4. No colored rings round arti- ficial lights. 5. Tension normal. 6. No oedema of lids. 7. Circum-corneal injection. 8. Cornea decidedly hazy and is hy- persensitive. 9. Blood-vessels may extend to cornea. 10. Ant. chamber normal. 11. Pupil NORMAL or contracted. 12. Accommodation good. 13. Visual field not contracted. Ophthalmoscopic appearances : 14. Hazy cornea usually obstructs a good view of the fundus. 15. Disease of youth. 16. Hereditary syphilis. 17. Peg or notched teeth. 64 HEMORRHAGIC GLAUCOMA. May be confounded with Albuminuric Retinitis. Hemorrhagic Glaucoma. 1. Vision suddenly impaired or lost. 2. Pain is apparently secondary TO LOSS OF VISION (T. + 2 — 3). 3. Tension increases rapidly after failure of vision. 4. Cornea may appear dull and smoky. 5. Anterior chamber shallow. 6. Aqueous may be turbid. 7. Pupil dilated and sluggish. 8. Iris may be discolored. 9. Ophthalmoscopic appearances (see page 72). ID. Hemorrhages may obstruct all clear view of the fundus. 11. No exudation in retina. 12. Arteries may pulsate. 13. No albumin in urine. 14. Rare under 40. 15. One eye affected. Treatment, Eserine (locally). Cathartic, salicylic acid. Sclerotomy. Enucleation. Albuminuric Retinitis with Hemorrhages (Retinitis Apoplec- tica). 1. Vision suddenly impaired. 2. Pain none. 3. Tension normal. 4. Cornea clear. 5. Anterior chamber normal. 6. Aqueous clear. 7. Pupil NORMAL. 8. Iris normal. 9. Ophthalmoscopic appearances (see page 46). 10. Hemorrhages usually small and flame-shaped. 11. Patches of exudation in retina. 12. Arteries do not pulsate. 13. Albumin in urine. 14. Any age. \ 15. Both eyes affected. SUB-ACUTE GLAUCOMA. 65 May be confounded with Conjunctivitis. Snb-Acute Glaucoma. 1. Vision impaired on nasal side of visual field. 2. Pain in eyeball and temple. 3. Colored rings or halo round artificial lights. 4. Discharge watery. 5. Circum-coraeal injection. 6. Cornea may appear dull and smoky. 7. Anterior chamber shallow. 8. Aqueous may be turbid. 9. Pupil dilated. 10. Tension increased. 11. Ophthalmoscopic appearances (see page 72). 12. Rare under 40. 13. One eye affected. Treatment, Salicylic acid internally. Eserine instilled q. 4. h. Iridectomy if tension increases. Conjunctivitis. 1. Vision not impaired except by mucus on the cornea. 2. Itching or burning pain in the lids. 3. No colored rings round arti- ficial lights. 4. Discharge sticky or purulent. 5. Whole conjunctiva congested. 6. Cornea clear. 7. Ant. chamber normal. 8. Aqueous clear. 9. Pupil normal. 10. Tension normal. 11. Ophthalmoscopic appearances normal. 12. Any age. 13. Usually both eyes affected. 66 CHRONIC GLAUCOMA. May be confoanded with Physiological Cupping of thi Disc, Optic Nerve Atrophy, Tobacco Ajublyopia, Posterior Staphylobia. Chronic Glaocoouu 1. Vision impaired, or lost (absolute glatuoma), 2. Visual field contracted, espe- cially on nasal ride. Central vision may remain fairly good. 3. Pain may be little or none. 4. Colored rings round arti- ficial lights. 5. Failure of accommodation. 6. Tension increased. 7. Circum-comeal vessels may be injected. 8. Cornea clear. 9. Anterior chamber shallow. 10. Aqueous clear. 11. Pupil may be normal, but it is usually a little dilated AND sluggish. Ophthalmoscopic appearances (see page 72) : 12. Rarely under 40. Treatment. Salicylic acid internally. £serine instilled q. 4. h. Iridectomy if tension increases. Phystoloi^ical Cep p ii ^ of Optic Disc 1. Vision not impaired. 2. Visual field normal. 3. Pain none. 4. No COLORED rings ROUND ARTI- FICIAL lights. 5. no failure of accommodation. 6. Tension norbcal. 7. EjLtemal appearance of eye normaL 8. Cornea clear. 9. Anterior chamber normal. 10. Aqueous clear. 11. Pupil normal. Ophthalmoscopic apfkarances (sec page 72>. 12. Any age. CHRONIC GLAUCOMA (Continued). 67 Chronic Glancoma. 1. Vision impaired. 2. Visual field contracted on nasal side, sometimes above and below, while the tem- poral field may remain quite GOOD. 3. Pain may be little or none. 4. Colored rings or halo round ARTIFICIAL lights. 5. Failure of accommodation. 6. Tension increased. 7. Circum-comeal vessels may be enlarged. 8. Cornea clear. 9. Anterior chamber shallow. 10. Aqueous clear. 11. Pupil may be normal, but it is usually a little dilated AND sluggish. Ophthalmoscopic appearances (see page 72). 12. Rare under 40. 13. No excess of alcohol or to- bacco. Alcohol or Tobacco Amblyopia. 1. Vision impaired. 2. Visual field not contracted, but scotomata for colors will usually be found. 3. Pain none. 4. No COLORED RINGS OR HALO ROUND ARTIFICIAL LIGHTS. 5. Failure of accommodation. 6. Tension normal. 7. External appearance of eye normal. 8. Cornea clear. 9. Anterior chamber normal. 10. Aqueous clear. 11. Pupil normal, or contracted. Ophthalmoscopic appearances (see page 60). 12. Adult and middle age. 13. Excess of alcohol or tobacco or both. TX* riaXES. Eiii..- HiHT . "■■■!■■ "■T — T^niiTTZZ ~ — '- "_Z"r^ - ' - - " 71 "^ ■ i rr:a . ^ ,.T., TFT -ZI»1I vCUTTZ: k ^lLt-L- ■^- *— *• • rrcx. ae CT-g^. but it is '\i.: . IZTTLZ DILATED jtXi"X^ JPSrSiLMDSCOMC APFEAiL.:«CES j-iif.rt^ ;— a.^.— rujs^ unr;. ». IC^ HrFBLMETmOPlA IS PRESEXT IN rTQ rHiitns of the cases. -ID. POSTERIOR STAPHYLOMA (Coxtinxed). 69 Posterior Staphyloma. 1. Vision usually impaired as a result of myopia, or choroiditis, or both. 2. Pain none. 3. External appearance of eye normal. Ophthalmoscopic appearances : 4. a large glistening white patch ON TEMPORAL SIDE OF DISC and continuous with it, although the outline of the disc can usually be seen. Not infrequently the staphyloma is several times as large as the disc, and almost surrounds it. UnABSORBED black PIGMENT MAY STILL BE SEEN IN THE STA- PHYLOMA, OR CLINGING TO ITS EDGES. 5. The larger blood-vessels appear to be driven in under the nasal side of the disci Small and STRAIGHT BLOOD-VESSELS PASS OUT AND OVER THE SHINING WHITE PATCH, to the temporal side of retina. 6. Myopia and choroiditis are associated in the great majority OF CASES. Opaqae Nerre-Fibres. 1. Vision normal. 2. Pain none. 3. External appearance of eye normal. Ophthalmoscopic appearances : 4. Irregular milky or glistening white patches extending into the retina from the optic disc, and continuous with it. No BLACK pigment DEPOSITS ARE SEEN IN OR AROUND THESE PATCHES. 5. Blood- VESSELS normal, and not in- frequently WHEN LEAVING THE DISC PASS UNDER A PORTION OK THE WHITE PATCH of Opaque nerve-fibres. 6. Myopia or choroiditis ark rarely seen with opaf^ue nerve-fibres. ^rnHvc^STzir ssiz:2^:znns m. iCSL ^ T. I. ^ Irrixaiinr rvr lender f?' «nc may & wmmc of tilt cibsTT Tc^ion or «n xrriuiied ij^ Ahove symjvjoms may all disap- pear, shDwinrr srmr, i'rriiatimi, cff the irriiaiiiig eye may be enu- cleated, yet the case 50 on to total destruction, proving con- clusi\»ely that it had been jvw/. Pain tjsuat.t.y one of the tost SniFTOlK. Bright uhht tsettates the XiACfiEYMAnOK DUE TO UGHT AND PAIK. Close wchle not tisesome but 3»AOBTn-. Pupil ccmtract^L PosttTior synedne. 1^0 wxnmd of the fellow eye. (Contintied on pi^ 71.} SYMPATHETIC INFLAMMATION (Continued). 71 Later stage, or sympathetic in- flammation. 9. Circum-corneal injection. 10. Tenderness on pressure over the ciliary region ; may be confined to one small spot. 11. Dots of opacity on endothe- lial layer of cornea (des- cemitis), 12. Pupil usually sluggish, with some posterior synechise. 13. Iris may be discolored. Ultimately : 14. Cornea hazy. 15. Aqueous turbid. 16. Iris infiltrated. 17. Vitreous filled with floating opaci- ties. 18. Retina and choroid involved. 19. Tension increased ( secondary glau- coma), 20. Anterior chamber shallow, fol- lowed by fluid vitreous (synch- isisj, diminished tension, and possibly phthisis bulbi. Treatment, Enucleate the irritating eye. Atropine cautiously. Hot fomentations. Colored glasses. Mercurial inunctions. 9. Circum-corneal injection. 10. no special tenderness over ciliary REGION. 11. No DOTS OF OPACITY ON ENDO- THELIAL LAYER OF CORNEA. 12. Pupil contracted, sluggish, or sta- tionary, with posterior synechias. 13. Iris discolored. 14. Cornea clear. 15. Aqueous turbid. 16. Iris infiltrated. 17. Vitreous clear, if seen. 18. Retina and choroid not involved. 19. Tension may be a little increased. 20. Ant. chamber normal. 72 OPHTHALMOSCOPIC APPEARANCES OF DISC. Glaucoma. Whole Disc Excavated (Cup-shape). 1. Color white, bluish- white, or gray. 2. All blood-vessels bend sharply OVER THE edge OF THE DISC. They may be seen indistinctly at the bottom of the 'cup, and can be brought into view by using a weaker convex (-f-) or stronger concave (— ) glass. 3. Arteries often pulsate. Atrophy of Optic Disc. Whole Disc Concave (Saucer-shape). 1. Color white or gray. 2. Blood-vessels pass from retina INIO THE DISC without MAK- ING A SHARP BEND OR CURVE. They are seen distinctly with the glass used to see the retina. 3. Arteries small and straight. Never pulsate. Physiological Cupping. Disc Partially Excavated. (Thimble-shape.) I. Centre portion of disc exca- vated, and possibly the excava- tion may extend to