Ophthalmic surgery / by J. F. Streatfield.

  • Streatfied, J. F.
Date:
[1872]
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmic surgery / by J. F. Streatfield. 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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    DIAGNOSIS OF GLAUCOMA.—PROLAPSE OF IRIS. forefinger on the ciliary margin of the patient's lower lid, and indenting the globe as he looks up. 2. Pai7i in and around the eye, which is often intolerable, generally intermittent. Rarely does a case of painless (non-inflammatory) glau- coma occur. 3. Halos are seen around the light. 4. Presbyojnc symptoms are pre- sent. 5. There is narrowing of the f,eld oi vision. 6. Theve are obscurations. 7. The ap'pea?-ance of the eye externally : a. Large tortuous vessels are seen to course over the sclerotic, and dip into it in the ciliary region ; h. The anterior chamber is shallow, the lens, and the iris with it, being, by pressure from behind, thrust forwards in approximation to the back surface of the cornea ; c. The pupil is large and inactive ; d. The cornea has more or less lost sensibility, and reflects light from its surface imperfectly ; e. The lens is perhaps cloudy (not cataractous, not opaque after iridectomy.) 8. Ophthalmoscojpic appearances. When the fundus can be seen (and it very often can be, though the aqueous and vitreous humours be somewhat obscured, even when the cornea looks steamy and the lens cloudy), the excaA^ation, more or less, of the entire surface of the optic nerve-entrance, and tortuosity and congestion and pulsation of the retinal veins (and arteries), which are displaced and compressed against the white margin of the cup, and some little ecchymoses therefrom, perhaps, are the marked features. These signs are all due to increased intraocular pressure, as is shown directly by the excessive tension (the first diagnostic sign given) in consequence of the contents of the globe being more than is normal. Glaucomatous is a term applied to symptoms of increased intraocular pres- sure (tension) in other diseased states of the eye, in which iridectomy is per- formed with much benefit to the patient : hardness of the globe being in any such cases whatever, the indication for the operation. As it is specially im- portant to recognise glaucoma in its first stages, we must not look for the corneal and lenticular changes, or much cupping of the optic nerve in all cases of the disease, or the operation will have been deferred long after it should have been done. Glaucoma is a disease of elderly or of old people of impaired health. The earliest symptoms are, to the patient, perhaps, intermittent obscurations, halos, and more or less wandering pain ; and, to the Surgeon, in- creased tension, some congestion, dilated pupil, shallow anterior chamber, and, ophthalmoscopically, some excavation of the optic nerve-entrance and venous pulsation. In the case of an eye blind by old neglected glaucoma, iridectomy will perhaps relieve pain ; but probably it should be extirpated. The benefits of iridectomy, properly performed, and sufliciently early in glaucoma, are patent; and it must be done, when the opportunity offers, even when the time most favourable for its performance is gone by, and even in the chronic cases, in which the results are always least advantageous. Without operation, glaucoma certainly ends in total blindness. It is probably, in the first place, choroiditis, and eff'usion in the vitreous space. It goes on by pro- ducing such structural changes in all the tissues of the globe, that total dis- organisation is the result. Prolapse of the Iris.—This means a bulging of the iris through an ulcer which has perforated the coats of the eye, or through a wound in these coats, either made accidentally, or in the course of a surgical operation. It is often caused by the first gush of aqueous humour as it escapes when the perforation is complete, and remains there passively until it is either pushed back into its place with a spatula or curette, or made to return hy causing contraction or dilatation of the pupil by instillation of a solution of (atropine or) Calabar bean, one or the other, as the case may seem to need. It is evident that, if the external opening should be in or very near the centre of the cornea, a prola])se of the iris cannot occur ; it cannot be very far from the corneal margin, the position in
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