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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    [103] Vision, or the image; “ things fade out” when looked at for a few seconds, and there is a great “ nervousness ” when the task is persisted in. The patient is compelled to renounce. This symptom, indeed, has always existed, but it was hardly noticed because of the vastly greater and more multiform suffering, and also because “ near work ” with the eyes was not persisted in. Since recovery the natural desire to read, write, and sew, has become more imperative, and the inability to do so more noticeable and strange. The significance of the fact lies in the possible incidence of the symptom and the terrible results from use of the eyes in those who cannot, as can this woman, renounce labor with the eyes at near-range. Despite all attention to refraction, correction of subnormal accommodation, physical exer- cise, and other therapeutic advice and device the “ fading image ” persists. With continuous fixation of a letter or word, either at 20 feet or at 14 inches, it fades to nondiscrimination or nonvision in three or four seconds. This is with either eye alone, or both together. In reading, etc., the patient is compelled to move the gaze constantly from one object to another in order to keep on with any continuous work, and if the eyes are forced for a too long task, there is ocular pain, nervousness, evident injury, especially the next day, and then any use at all is impossible. The upper ophthalmic vein of the right eye passes under the artery at the disc, is engorged before reaching it, and empty, almost invisible, afterward. There are numerous other crossings, and venous pulsation is present. The crossings and pulsation are similar in the left. After massage of the eyeballs in the office the images were held for about two seconds longer than usual, j but such massage carried out at home afterwards seemed to produce other symptoms such as headache, etc., and the patient would not go on with it. Case IV is that of a young man of 25, whose eyes at ten were so bad that he “ could not distinguish food and dishes upon the table.” Headaches attributed to constipation, troubled as a child, j and there were attacks of sick-headaches, without vomiting, with pain over the right eye, etc. He has noticed that he has had to look aside constantly for an instant in order to fix any object at all persistently. The fading-image symptom was verified. He was and remains naturally left-handed, but was taught to write with the right hand. There has long been noticed “ blurring of vision ” 1 with near-use of the eyes. The eyes burn, insomnia is complained of, etc. Thinking the symptoms due to his uncorrected astigmatism I ordered B. E. + Cyl. 0.75 ax. 90° for constant use. My error was more excusable because of his amblyopia, which with the best lenses was 20/40 each eye, but more marked with the right eye. I found a vascular choking especially of the right, which kept me on my guard, and made me caution the patient that if