Disturbances of the visual functions / by W. Lohmann ; translated by Angus Macnab.

  • Lohmann, W.
Date:
1913
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Licence: In copyright

Credit: Disturbances of the visual functions / by W. Lohmann ; translated by Angus Macnab. 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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    tions of the optic nerve between the eye and the inside of the skull are designated as retrobulbar neuritis (haemorrhages, exuda- tions, or syphilitic new formations may be the cause, also the spread of an inflammation from the nasal sinuses to the periosteum of the orbit and the permeural sheath of the optic nerve.^ Multiple sclerosis contributes n:iany examples of this affection). The central defect may be so great that there only remains a crescentic portion of the temporal field ; after a temporary almost complete amaurosis such a field will show^ a recovery first for white and later for red and blue. Central Scotoma in Posterior Sinus Disease.—Birch- HiRSCHFELD demonstrated, and emphasized, that when a diseased process, originating in an inflammation or a tumour of the posterior nasal sinuses, attacks the optic nerve or the orbit and causes a severe disturbance of the vision even to the extent of blindness, the first eye symptom is the formation of a central scotoma. In reference to the importance of an early recognition of such a scotoma, we can heartily support Birch-Hirschfeld when he declares it to be of the greatest clinical value in the extremely difficult diagnosis of the affections of the sphenoidal and pos- terior ethmoidal cells. In contrast to the scotoma due to alcohol and tobacco, this develops rapidly and shows great tendency to progression. According to Hoeve,^ an enlargement of the blind spot for colours precedes the scotoma ; it is in the progress of the disease that a central scotoma develops, and fuses with the enlarged blind spot. Hoeve's symptom has been freely confirmed ; Gjessing^ recorded its occurrence in 50 per cent, of the cases of visual defect due to nasal disease. In posterior sinus disease this last author described ring scotomata often surrounding the fixation point. Many such cases have been described,^ but it is difficult to say to what extent they are functional and not caused by the neuritis. Ham records a case in which hysteria was established. De Kleijn,*^ who confirms the enlargement of the blind spot in posterior sinus disease, also found some peripheral contraction of the field without any explanatory ophthalmoscopic signs. Central Scotoma in Neuritis and Optic Atrophy.—The central scotoma occurring in infiammatory and atrophic conditions of the optic nerve is obviously an expression of the vulnerability of the papillo-macular bundle. In his article in Grafe-Samisch Uhthoff states that a central scotoma is rarely seen in tabetic atrophy. Fuchs,^ on the other hand, says that he has seen this 1 EvERSBUSCH and ]^irch-Hirschfeld in Grafe-Samisch's Handbuch der Augenheilkunde. - Arch.f. Ophfhal. Ixv. ^ Arcli. f. Augenlieilk., Ixiv, and Ixvii. ^ Arch. f. Ophthal, Ixxx, I, MacWhinnie : Neiu York Med. Journal^ 1910; Euss Wood : Lancet, 1910; Ham, Ned. Tijd. v. Gen., 1911. ^ Arch. f. Ophthal., Ixxix. Amer. Ophth. Congress, 47th meeting.