Intra-ocular tuberculosis / by Walter H. Jessop.

  • Jessop, Walter H.
Date:
[1905]
Catalogue details

Licence: In copyright

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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    tubercles, and this accounts for the fact that their presence gives rise, as a rule, to no definite symptoms. Microscopical.—The changes are deep—generally in chorio- capillaris layer and from adventitia of the larger vessels. Duckler says that the giant cells are rich in pigment; but Margulies, on the contrary, states that giant cells have no pigment, and are derived from endothelial and connective tissue elements ; there is always to be found the tubercular reticulum, numerous endothelial cells, and, quite early in the disease, caseation. Tubercle bacilli are often to be met with. Haab, who first described the bacilli in tuberculous choroiditis, found them in nearly every case; Lawford (13) in only 2 out of 6 cases, though in all 6 cases tubercle bacilli were found in the meninges. Ocular Lesions.—The sclera is affected rather than the re- tina ; the lesions are often difficult to see post mortem, unless the retina be stripped off. Diagnosis.—The absence of black pigmentation and of the ringed spots distinguishes choroidal tubercle from disseminated choroiditis. It is sometimes difficult to diagnose from spots of choroidal exudation, but in tubercle the nodules are rounder, the colour greyer or more yellow, the edges not so soft and with the peculiar moth-eaten appearance; in the exudation due to syphilis vitreous opacities are present. If the nodules are found early in the disease they are an important aid to diagnosis; I have by these means been able to diagnose cases of tubercular meningitis from typhoid fever ten days or so before death. Prognosis.—As far as I know, patients never recover when the choroid is affected by miliary tubercles, as is also the case in acute miliary tuberculosis. In the St. Bartholomew's Hospital statistics in 1896 some cases of diagnosed acute miliary tuberculosis did not die, but since that time all such cases have succumbed. Treatment is confined to relieving the general symptoms of the patient, and no local treatment is of use. I have no knowledge of the effect of tuberculin in such cases. B. Chronic, Solitary, Aggregated, or Conglomerate Tubercle of the Choroid presents clinically quite a different picture to that associated with miliary tubercle of the choroid. In a few cases, however, the later result has been a secondary miliary tuberculosis of the meninges from absorption of tubercle virus from the first focus. The condition was first diagnosed by Horner (n) in 1878 in the case of a boy 8£ years old (Case 2), and Haab(12) has