The clinical value of repeated careful correction of manifest refractive error in plastic iritis / by Charles A. Oliver.

  • Charles Augustus Oliver
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Credit: The clinical value of repeated careful correction of manifest refractive error in plastic iritis / by Charles A. Oliver. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    \\.v&\y and objectively in every case that could be steadily watched and persistently followed by the following routine of condition: H h Ah, Ah, Ahm, Amh, Am, and M + Am. (3) In cases of plastic iritis occurring in young highly hyper- metropic eyes, especially where corrections had never been worn or were originally too weak, the refractive changes seemed in most in- stances never to reach those recognized as myopia; the decrease of the hypermetropia appearing to vacillate some one to three diopters less than the total hypermetropia, and this being accompanied by var>'- ing expressions of astigmatism. (4) In quite a number of cases of plastic iritis that could be properly studied by the ophthalmometer there appeared minor though at times plainly appreciable degrees of curious lessenings and increases of the corneal curvatures in the same case at different periods of the disease. (5) In nearly every case of plastic iritis that could be carefully and repeatedly studied by the ophthalmometer (even after any tech- nical and mechanical error in the method had been expunged), the corneal changes seemed to register much less in proportion to those found in the same cases by other objective methods and the subjective plan of lens testing ; thus indirectly showing the undoubted presence of lenticular disturbance. (6) In some cases of commencing iritis, especially in hypermetropic eyes, there seemed to be a most active clonic spasm of the ciliary muscle, causing rapid increases and decreases of lenticular form, so pro- nounced, in fact, that it became at times impossible to obtain any definite refractive result. Moreover, in this class of cases, persistent pupillary contraction often took place the moment any important curative measure was lessened or temporarily suspende*d. (7) In many cases of the plastic form of the disease, where there were points of ciliary tenderness of no matter how trivial a nature, especially when associated with irregularity of pupil form, the astig- matic changes seemed to preponderate and remain more or less fixed for long periods of time. (8) Experimental research by the use of repeated instillations of strong solutions of eserine in such cases, showed marked refractive increases and all manner of change in the principal astigmatic curves; these peculiarities expressing themselves not only subjectively by the patients' assertions with trial lenses, but evidencing themselves by retinoscopic and other objective methods. (9) In every case of iritis where there was much visible pigment deposition, or where the crypts of the iris were thickened and infil- trated, and the pupil, although apparently equally, enlarged in all meridians, refused to dilate to any more than to one-half or two-
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