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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    [102] superior temporal artery of the right eye. The patient said: “ Oh, everybody has noticed that,” but adding that it had no significance. The artery close to the disc turned upon itself, forming a circle about 10° in diameter, and passing under itself proceeded onward toward the macula. But in passing beneath the vessel was flattened by the pressure of the vessel about it, and from that point the artery was pale, half collapsed, and evidently carrying but a small quantity of blood. The macula was stippled and somewhat morbid in appearance, but otherwise the eye-ground seemed normal. My glasses had given no relief; there was a decided tendency to shut the right—the naturally dominant and important dextral eye—out of function; no device had given hope; the subnormality of accommodation of the right eye was about 1 D. greater than in the left eye—a significant fact; the amblyopia had not bettered under proper glasses; the symptoms, partly those due to eye-strain, were so peculiar as to arouse suspicion that more than ametropia was the matter,—such were the conditions which directed attention to the hitherto neglected looping of tne upper macular artery, and the plainly lessened blood-supply of the retinal area supplied by it. I at once ordered a blinder worn nearly constantly before this eye. A more certain test would have been a bandage, because, according to the physio- logic law of imperative function, the right eye must struggle for life and dominancy during all the years it is dying. In a few weeks the report was that while there was not by any means complete comfort, there had been a decided lessening of the severity of the pain, etc. The most significant fact was this: While the blinder was worn there was comparative freedom from pain, etc., but when it was removed a throbbing pain came on, which did not disappear until the blinder had been worn again for an hour. I then knew my theory was correct and that there was nothing left but to exclude the ailing eye from function. A large black lens was provided to be worn absolutely constantly, and relief was soon secured. After a life of excruciating suffering the patient wrote (a year after first consulting me): “I am sure it will gratify you to know that my eyes are relatively comfort- able; the blinder is a lasting success.” Eloquent testimony to the reality of the suffering and also of the cure, is shown by the willingness and necessity of wearing the hideous blinder all the time. Case II.—There had been failure of seven oculists, the last myself, to relieve a healthy strong young man of 20 years of age of “ inability to use his eyes.” His greatest complaint, upon persistent questioning, is that he becomes suddenly blind, or nearly so, when looking at anything. Things fade out and become nearly and wholly invisible. Even in the street, in looking at a person, the bodily figure grows dim or invisible; when playing (H