Ophthalmovascular choke / by George M. Gould.

  • Gould, George Milbrey, 1848-1922.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Ophthalmovascular choke / by George M. Gould. 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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    thinned and flattened out forming the fixed single layer or [107] network of arteries and veins, thus giving more extended areas of functional retina; and other shading mechanisms have also replaced it in function. In this retrenchment, flat- tening, and immobilizing process, and aided by other evident factors, it is but natural that intervascular crossings should occur with resultant pressure on the underlying vessel, dimi- nution of its lumen, impeded flow of blood, etc.,—in a word, what I have called “ infrabulbar choke.” When the functional interference may become pathogenic and beget morbid denu- trition of the difficultly nourished macula, is a question purely of circumstance, condition, and clinical demonstration. The fading image appears a natural consequence and symptom, and once put on our guard and made watchful for it, its clinical appearance is easily recognized, and of far-reaching significance. Some practical lessons and cautions may be gleaned even from these ten cases: The fading image in each eye singly, demonstrates that it is not due to muscular imbalance, and a number of other tests make this clearer; one must be on his guard against confounding this symptom with that due to long-continued eye-strain, from uncorrected, or what is worse perhaps, badly corrected ametropia. In amblyopia per se the symptom may be found or rather simulated, but is easily differentiated if care is exercised and the entire case-history is meticulously followed and coordinated with the existing s} mptom-complex. There is no excuse for the lessening of the exquisite care and conscientiousness required to eliminate the moie fiequent and common eye-strain, for proper glasses usually lessen the evils of the vascular denutrition, and re- lieve the symptoms heretofore ascribed to it, while, also, that may be the sole means of making life happier and possibly endurable; subnormal accommodation must also be looked sharply after, and solicitously excluded or allowed for; the time required tor the fading must be measured for each eye [iosi singh and for both together, and the results compared with the usually corresponding anatomic and functional conditions as shown by the ophthalmoscopic examination of each eye- giound, for, as everywhere else, and particularly here, there (10)