Intra-ocular tuberculosis / by Walter H. Jessop.

Walter Jessop

Date:: [1905]

Credit: Intra-ocular tuberculosis / by Walter H. Jessop. 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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$according to the latest views. Horner stated that: It seems 1 as if the pia cerebri takes the place of the pia oculi, and ! therefore if the pia mater of brain is tubercular, the pial : sheath (choroid of eye) is immune. Gowers (10) observed that choroidal tubercle is more common iin cases of tuberculosis without meningitis than those with 1 meningitis. My own opinion is that it is rare to find miliary ; tubercle of the choroid without tubercular meningitis; just :as tubercular meningitis is seldom met with without general i tuberculosis. Osier says that tubercular meningitis is always • secondary. Miliary Tubercles of the Choroid occur, as a rule, as small (.discrete grey round or oval nodules, varying in size from a 1 mere speck, 0.2 mm. to 1 mm., rarely larger unless some nodules {become confluent, when the size may be 2 to 3 mm.; the nodules fare very slightly if at all raised, the retinal vessels passing t uninterruptedly over them. They are generally two, three, or : four in number, but as many as sixty-two have been found in tthe same eye. By the ophthalmoscope they are seen as small ywhite, grey, yellowish, or rose-pink discrete spots; they are wery slightly if at all raised; the edges are soft and have a imoth-eaten appearance; the retina over them is clear, and the ccontour of the retinal vessels is uninterrupted; in some cases t there is a grey stippled appearance due to numerous minute y white or grey specks (tubercular dust). The nodule, as seen t by the ophthalmoscope, is really much smaller than the real i lesion, as owing to its depth in the choroid only the most I prominent part from atrophy of overlying tissues becomes \ visible. It is probably this fact that accounts for the sudden and apparently rapid appearance of the tubercles. There is no tendency to marked pigmentation, though at t times the edges are slightly tinged with greyish black pig- 1 ment; retinal hemorrhages are rarely to be found; the 1 vitreous is clear, no opacities being present. Optic neuritis t may be present; in 15 cases of miliary choroidal tubercle at • St. Bartholomew's Hospital, optic neuritis was said to be I present 9 times. The neuritis in these cases was probably due I to the accompanying meningeal or cerebral lesion, and quite distinct from the choroidal lesion. The position of the nodules is generally near the optic disk or yellow spot region, and therefore within the equator; but I they may, if multiple, extend towards the periphery; a favourite situation is near the retinal veins. The acuity of vision is probably little affected by choroidal$

Intra-ocular tuberculosis / by Walter H. Jessop.

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