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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    the fading-image symptom persisted he should change his occupa- [103] tion to one demanding the least possible use of the eyes lot neai- work. This choking was manifest to me in a unique crossing of the upper ophthalmic vein of the right eye over the artery, in such a way that the vein rose over the aiteiy in a sharp half- circle, like a letter n, the artery crowded beneath and within, and filling all the space. There was manifest choking and stasis. Similar conditions existed in the left eye, but less marked. There was long venous pulsation in both eyes, with congested and highly stippled maculas. Case V is that of a woman of 34 whose clinical history consisted in “fading image” (spontaneously complained of), headaches, and many swooning or fainting attacks. She “ had all the diseases of childhood,” “ remaining in a dark-room a long time,” “ a protracted attack of malaria,” etc. Her general physician thought another long illness 15 years ago was a return of the “ malarial infection,” but she was cured at once by some glasses secured at the time, from a good refractionist of another city, and the “ malaria ” has never recurred. Whenever she did not use the glasses there was a recurrence of headaches. She has had many oculists and I found the last one had ordered R. + Cyl. 1.00 ax. 75°, L. + S. 0.50 + C. 0.50 ax. 90°, with + Sph. 1.00 added for near work. The headaches start in the eyes and extend to the occiput, have been: particularly severe during the last year and a half, with nausea in the morning until she puts on her glasses. Feelings of nervousness, hurry, irritation, etc., were also com- plained of. She “ faints away ” on the least provocation. The swoonings began in late childhood, and she falls to the floor unless she hurriedly sits down when she feels them coming on. With proper correction of ametropia, the image fades in the right eye in three to four seconds. Early in the morning the image is held twice as long as after use of the eye during the day. The fading is “ typical,” i. e., the image goes out entirely and returns com- pletely. In the left the image is held longer and is a blurring and indistinctness rather than a full disappearance of the image. With both eyes the failing comes on in about eight seconds. Full clearness of the image recurs in about eight seconds. In the right eye there is venous pulsation, the superior ophthalmic vein passes under the artery, and afterward it is only one-half the size from this crossing until it enters the nerve. It is swollen and turgid before the crossing. There is no venous pulsation in the left, less venous clogging, seemingly because the vein passing under the artery just at the point of turning to enter the nerve, is not so much choked. While held, the visual acuteness of the right eye was at first only 20/40; after wearing glasses awhile it