A manual and atlas of medical ophthalmoscopy / by W.R. Gowers.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    36/392 (page 20)
    In a case of supposed aneurism of the arch of the aorta, Becker found marked pulsation in the left eye, while in the right onl}^ a trace of pulsation could with difficulty be detected. Pulsation in an extreme degree appears to be sometimes phj^siological. It was present in a man imder my care who had also a very faint diastolic basic murmur but no hyper- trophy or dilatation of the left ventricle, so that there was certainly not enough aortic regurgitation to account for the pulsation. A capillary pulse could readily be obtained in the forehead. The increased pulsation seemed to be in the smaU arteries only, since at the wrist, even when the arm was raised, the artery had the normal pulse-characters. In the eye, pulsation was conspicuous in both arteries and veins, and sKght pressure on the globe increased it to such an extent that some veins on the disc, of full size in the diastole, actually disappeared at each systole. Moreover, the diastole of the arteries corresponded to the systole of the veins, and the pulsation in the latter must therefore have been due to the mechanism to be presently mentioned. Capillary pulsation has been described in aortic regmgita- tion—a pulsatile redness of the disc—due to the intermitting distension of the capillaries in consequence of the great fall of pressm-e between the successive pulses. Such an appear- ance is, however, very rare, and can seldom be detected even when a pulsatile blush is \asible on the forehead. Venous.—Pulsation in the retinal veins may fi-equently be observed as a normal condition, chiefly in the large branches upon the optic disc,^ especially where the veins curve down the sides of the cup. It is abnost constant in aortic regurgitation, and is much more frequently con- spicuous in this disease than the arterial pulse. Several explanations have been given of the venous pulse. The theory which is, perhaps, the most plausible explains the pulsation by supposing that where the artery and vein are near together, in the sclerotic ring or optic ^ Messrs. Lang & Barrett found a venous pulse on the disc in 738 per cent, of the eyes examined by them at Moorfields. Ophth. Hosp. Rep., vol. xii. p. 60.