Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1879]
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Licence: Public Domain Mark

Credit: Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    [From the British Medical Journal, June 14th, 1879.] PEATED PAROXYSMAL FAILURE OF SIGHT, IN CONNECTION WITH HEART-DISEASE* By EDWARD NETTLESHIP, F.R.C.S., In the cases, by no means uncommon, in which patients come under care for temporary failure of sight, in a large proportion the symptoms are due either to megrim, or to a temporary and varying failure of accommodation, or to some less common local conditions. But a few cases remain in which we can invoke neither central nervous disturb- ance, as in megrim, nor any transient nervous or muscular failure of accommodation, and of which temporary arrest of blood-supply to the retina seems the only feasible explanation. These patients who, so far as I have yet seen, are always the subjects of valvular heart-disease, are subject repeatedly to loss of sight for a short time. The attacks vary considerably in severity, but they all agree in general features ; the failure comes on suddenly, lasts a short time (from a few minutes to an hour or two), affects only one eye, and passes off almost as quickly as it came on. Not only is the affection asymmetrical, but the same eye suffers repeatedly, whilst its fellow may escape altogether. In certain of the cases, an attack at length occurs which, instead of passing off as usual, leads to permanent blind- ness. Such cases, although rare, are well known and have attracted the attention of many observers (especially Kijapp, Moos, Loring, Mauthner), and various explanations have been offered. The fact that the cases occur in connection with heart-disease seems to point to some circulatory disturbance as the cause of the sym- ptoms. The difficulty is to explain a disturbance or arrest of blood- supply which, whilst it happens repeatedly, is, as the symptoms show, not only very localised, but always affects precisely the same part. We cannot suppose that the same artery, whether in the eye or the optic centre, is repeatedly plugged by embolism ; nor can the symptoms be accounted for by a general failure of the cerebral circulation, nor by fainting ; for the patients, though often suffering much from headache and giddiness, never actually faint during the attacks, nor does either posture or exertion seem related in any way to their onset. We seem to be driven by exclusion to the hypothesis of some permanent local di.sease of the ophthalmic artery, or its branch to the retina. Thus, whilst we can readily suppose that disease of the arterial coats, narrowing the bloo<l-channel to the retina, might cause no symptoms, so long as the general circulation was healthy ; we may note that the local conditions mentioned below make it likely that if, with the ophthalmic artery narrowed by disease, the intracranial circulation were also liable to disturbance from heart-disease, the stream of blood to the retina might now and then be suddenly stagnated for a short time. Tl-ie natural elasticity of the coats of the eye offers an especial obstacle to the entrance of blood ; the arterial twig which supplies the retina is Ophthalmic Surgeon to St. Thomas's Hospital. * Read at a meeting of the South London District of the Metropolitan Counties