Subjective symptoms in eye diseases / by George A. Berry.

  • George Andreas Berry
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Subjective symptoms in eye diseases / by George A. Berry. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    it, limited, however, to the one eye, occurs iu embolism of one of tlie principal branches of the central artery of the retina. Tlie defect is generally in the up])er or lower half of the held. This condi- tion is not infrequently wrongly called hemianopsia superior or inferior. After embolism of the main artery a sniall ])eriphei'al portion of the temporal side of the^held retains often more or less completely its function, a fact which it is well to bear in mind, as the ophthalmoscopic appearances, after a certain time has elapsed, are often slight and undecided ; and this condition occurriiig on the one side, especially in a subject the state of whose circulatory system would render embolism possible, is strongly suggestive of the blindness beini>- due to this cause. Scotoniata occur either in connexion with lesions of the retinal elements or independently of gross anatomical alterations, generally owing to some I'unctional intra-cranial or cerebral disorder. The first may be of traumatic, inflammatory, or vasomotor origin, or be due to malformation. The cause is generally evident on ophthal- moscopic examination. The affected regions give rise to ^^ti^'^ scotomata, of which the patient is most conscious wdien the centre IS affected. This form is found in the different kinds of choroiditis, traumata, and luiemorrhages of the retina and choroid, opaque nerve fibres, coloboma, retinitis, etc. In diffuse retinitis a zonular or ring-shaped scotoma may often be found, either complete or inter- rupted at intervals, without any corresponding ophthalmoscopic changes. A form of choroiditis occurs in old people which is limited to the region of the macula lutea, and is often not very easily detected owing to the exudation, or senile changes of the basal membrane, differing only slightly in colour from the rest of the fundus. It gives rise to very dili'erent degrees of blindness, generally sufficient, however, to render the reading of newspaper type impossible. Owing to the limitation of the pathological change to the centre, complete blindness never results from it. Large or small insular scotomata not implicating the centre or ex- tending to the periphery, for which no objective reason can be detected, are occasionally met with. The origin of these is obscure. The prognosis is good as far as blindness goes if the function of the surrounding portions of the retina remains normal, but the scotomata are not likely to disappear. Fig. 5 is the field of the left eye of a lady aged 40, in whom there were no ophthalmoscopic appearrnces or any history of exposure to strong light. The con- dition remained unaltered for several months, after which I did not see her again. The right eye was normal. Glaucoma.—In this disease Von Grsefe showed long ago that the condition of the field afforded an indication of primary diagnostic importance. The limitation which takes place is usually most marked to the nasal side (inwards and downwards).^ Frequently this ^ On this point Mauthner holds a different view. See his recent work on glaucoma.