Atlas fundus oculi / by William Holland Wilmer.

  • William Holland Wilmer
Date:
1934
Catalogue details

Licence: In copyright

Credit: Atlas fundus oculi / by William Holland Wilmer. Source: Wellcome Collection.

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    variety of conditions. The drawings are accurate, and the delicate modulations of colour are reproduced with great skill. We may see in these plates, as though looking through the ophthalmoscope, the fundus of different types of human beings, of different races, and of a wide range of pathological conditions. On this account, therefore, the reproductions of the pathological changes in the fundus are of unusual value, both to the ophthalmologist and to the clinician; for there is, perhaps, no structure in the body that reflects so frequently and so definitely such a variety of diseases that affect the body generally. One may see, in this small space, the head of the optic nerve, a meshwork of arteries and veins, as well as irregularities in the disposition of the pigment. Inflammatory reactions, secondary to infections affecting distant portions of the body, are prone to involve the highly vascularized tissues of the retina and choroid, while intoxications that may not produce a visible result elsewhere, may cause changes that can be detected in the fundus. Since it is necessary to conceive of the fundus oculi as a tissue of the body that participates very frequently in general disease processes, it seems appropriate, in this introduction, not only to mention this well-known fact, but to develop the subject somewhat further. The acute infectious diseases form an important group in which the fundus is not infre¬ quently affected. During the course of the acute exanthemata, and in such protracted infec¬ tions as typhoid fever, one may at times observe an optic neuritis with reddening of the disks, injection of the small vessels about the periphery and blurring of the disk margin. In rare instances an inflammatory reaction may appear in the choroid. Much more common, however, and perhaps of greater practical significance are the changes that are often observed in the retina in general bacterial infections and as complications of septic processes. The small lenticular or round hemorrhages, which may be frequently seen in the retina during the progress of subacute bacterial endocarditis, are as significant as the petechiae which appear in the conjunctival mucosa or in the skin of the body. The retinal hemorrhages, like those in the mucous membranes and in the skin, are usually punctuated by a yellowish central dot, and are prone to make their appearance and then undergo rapid absorp¬ tion. The detection of these small hemorrhages in the retina of the patient, suspected of having subacute bacterial endocarditis, adds further evidence for the diagnosis. Embolism of the central artery of the retina is a rare and more serious complication. It often explains the sudden attack of blindness from which these patients may suffer. Suppurative processes in distant parts of the body may be accompanied by profound changes in the fundus oculi. Hemorrhages scattered through the retina, as well as optic neuritis, are not infrequent. Occasionally a pronounced neuroretinitis may be observed. The nerve head is swollen, and hemorrhages and exudates are numerous. Such extensive alterations are to be observed in suppurative pyelonephritis, in severe infections of the para¬ nasal sinuses, or in instances of sepsis dependent upon suppurative thrombophlebitis. In the last condition infected emboli may be carried to the choroid or retina, causing the most violent forms of acute choroiditis and retinitis.