Treatise on the diseases of the eye : including the anatomy of the organ / by Carl Stellwag (von Carion) ; translated from the fourth German edition and edited by D.B. St. John Roosa, Charles S. Bull, and Charles E. Hackley.

Karl Stellwag von Carion

Date:: 1873

Credit: Treatise on the diseases of the eye : including the anatomy of the organ / by Carl Stellwag (von Carion) ; translated from the fourth German edition and edited by D.B. St. John Roosa, Charles S. Bull, and Charles E. Hackley. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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$. and which may even induce inflammatory proi B sides, when the sensibility of the eye and its covering disappears, the real motive power of the rhythmical and involuntary closure of 11»■ - lid U also gone; the eye remains open ami allow-tin' exposed conjunctiva] surface to become dry. This is more apl to occur, because in any interruption of the conducting power in the first branch of the fifth pair, the lachrymal glands must be deprived of the nervous power which regulates the secretion, and thn^ the secretion of tears l>c diminished, even reduced to the slightesl quantity [Qratfe, HippeT). Acute xerosis is very apl to occur, the epithelium of the cornea ami conjunctiva, especially in the parts exposed, by the palpebral fissure, Hakes off, bee »mes rough, and covered with delicate mucus, which hardens into crusts. And thus another factor is produced which acts upon the nu- trition of the part, and greatly favors inflammation and ulceration. Indeed, numer- ous experiments leave no douht that closure of the palpebral fissure, that is to say, protection from injurious external influences and from drying of the secretions, may. in the majority of cases, prevent the appearance of neuro-paralytic ophthalmia, and in case it has occurred, cause it to recede. Some even consider that neuro-paralytic ophthalmia i- caused by injuries unavoidably produc <1 in the absence of protection to the eyes (Snellen, Rosow, Knapp), or by the anaesthesia of the parts and the ac- companying stoppage of the lachrymal secretion {Qraefe). others again believe, that on account of the impairment of the conducting power of the sympathetic nerve, there is a lessening of the resisting power of the tissue (Biittner, Samuel). Against this view it may he said, however, that covering the eye does not furnish an absolute immunity from the disease (SrJn'Tf\ Hlpp/l), and that neuro-paralytic oph- thalmia is not at all connected with ana'sthesia. but that it has been observed wdien the parts were perfectly sensitive (Schiff, Geissler, Steffan, Mboreri). The influence of the portion of the sympathetic conm cted with the trifacial, upon the circulation and nutrition, is seen not only in the complex symptoms of the neuro-paralytic ophthalmia, but also in the so-called secretion neroses connected with neuralgia of the fifth pair, and in the atrophy of the connective tissue, of the muscles, and even of the bones, which is sometimes found as a consequence of long existing neuralgia and anaesthesia of branches of the fifth pair (Benedikt, i't/-,!■ r) ). But this influence is most clearly seen in herpetic or the so-called phlyctenular of the parts supplied by the trifacial. There is scarcely any doubt, accord- ing to tin- few anatomical investigations that have been made, that herpes has a close causal connection with inflammatory processes which have localized them- selves in the track of bundles of sympathetic fibers {I)<ntifhs<n, Exnmrrk, n<imi- gprung, <'lmrr<>t. Cotard). It is also certain that the seat of the morbid collection will determine the location ami. extent of the characteristic eruption. Morbid processes, which have become developed in the region supplied by tin- frontal or lachrymal branches, or in the course of the naso-ciliaris, beyond the branching off of the ciliary nerves, in accordance with the anatomical conditions, can only directly affect the circulation and nutrition in the accessory portions of the eye. But the influence which they may exert upon the circulation and nutrition of the globe i-. theref ire. greater. The reflex relations between the sympathetic and the sensory fibers, not only of the fifth pair, but also of all the sensory nerves, here come into consideration. These relations are very important in pathology and therapeutics.$