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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    eyes, but also in the temples, forehead, and hack of the head. 1104] This was constant, she was never free from it, even in the night. Whenever she tries to use the eyes she has intense nausea and a “ faint feeling,” and can sleep at night only if she has not used her eyes at near-work during the day. Constipation has been severe. She has lived an out-of-door life, having neither read, written, or sewed for years. “Muscular rheumatism” (mis- named!) has existed from childhood, and photophobia and epi- phora have been troublesome. She was wearing B. E. + S. 2.00 + C. 0.25 ax. ISO0, and had been using glasses for about six years. Her static error I diagnosed: R. + S. 2.00 + C. 0.37 ax. 180° — 20/20 L. + S. 2.00 + C. 0.25 ax. 180° = 20/20 with 12° of esophoria. Her last oculist had advised tenotomy, but fortunately this was not accepted. Her general physician pronounced her disease to be “ due to a neuropathic condition of the general system,—in a word a neurosis,”—the ancient modern naming of an unknown condition with a meaningless word. I ordered the above correc- tion less 0.37, for constant use, and one year later there had been but little improvement. She lived far away and I begged her, unwisely as it proved, to have thorough examinations and treat- ment, by the best general physicians. But these had no good result, and, after having used and disused bifocal glasses for possible subnormal accommodation, I had her make another journey to me. By this time I was on the lookout, in such cases, for the fact, and the causes, of the fading-image symptom, and at once it was demonstrated. The refraction, etc., remained essen- tially as before. The main trunks of all the vessels passed over or under each other several times, but there was no venous pulse. The image of either eye alone could be held for three, or at most five seconds, and with both eyes for three seconds. With attempts to hold it longer the eyes filled with tears. Any jar makes the eyes throb, and stooping produces this at once. The blurring or fading seems like a pulse-wave that comes and goes. The image is not held better in the early morning. She raises her eyes and eyebrows constantlj in attempting to look at anything. She finds she dare not go to church, theater, parties, etc. She has the curious and anomalous ability and habit, when attempting to concentrate ” or fix her gaze, of raising the right and lowering the left eye, at the same instant. Her local oculist, a skilled and conscientious man, thinks the trouble comes from the esophoria, but this cannot be when the image fades with either eye used singly. I shall not consent to tenotomy, although massage and other possible therapeutic measures seem useless. The rules of life and of practical living are clearly indicated.