Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1879]
Catalogue details

Licence: Public Domain Mark

Credit: Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship. 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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    From the end of August to the enrl of October, he attended Dr. Greenfield, and took belladonna and sal volatile with great benefit to the headac-bes and beating in the temples. In December, he got a cough, and has since then had more palpitation and .shortness of breath. I'lec. 23rd. While returning home by train in the evening, the sight of the right eye again went away. He described it as like a cloud passing quickly over the sight, and thought it reached its acme in about a minute ; he said it was not absolutely siulden. Having to change trains, a friend led hiin lo a seat, and he waited till the sight returned. This occurred in about half an hour, the sight returning quite quickly, so that it came back all at once in a minute. This, he said, was the only attack since August ist. The dimness was not attended by either headache or giddiness. It is particularly noted that faintness was never a concomitant symptom of the failure of sight. The sight of the right eye was normal, whenever tested, allowance being marie for a low degree of myopic astigmatism. The ophthalmo- scopic appearances of the disc were consistent with health, although the retinal arteries were if anything too large, and pulsated on the slightest pressure (not quite spontaneously, as in the left eye); there were some small filamentous opacities seen in the vitreous body, near the disc. Though central sight was normal, the field of vision was smaller in all directions than in health, and the visual field for red was markedly contracted, conditions which might probably be accounted for by a deficient general supply of blood to the retina. He was afterwards for a short time in the hospital under Dr. Stone, but getting worse refused to remain. He had an attack of partial dimness, complained much of accommodative asthenopia, and the pupils were larger than in health. There was a small diffused ecchymosis on the sclerotic of the right eye. Whatever may be the precise explanation of such cases as the above, the association of the eye-symptoms with serious heart-disease makes it a matter of some clinical interest to distinguish between them and some of the more trivial affections. From cases of dimness due to variations of accommodation the heart cases are as a rule, easy to diagnose. This accommodative failure generally occurs from overuse of eyes which are optically defective (usually hypermetropic) and need spectacles, and it is seldom asymmetrical. But it must be admitted that in the accommodative cases, and in some few others, e.g., some cases of threatened glaucoma, the distinction cannot always be drawn so easily as would be expected on theoretical grounds. But the cases of megrim blindness are, I think, those in which the distinction is of the greatest importance and at the same time most difficult to draw. It is well known that certain of the subjects of megrim are liable to a very peculiar affection of sight, in which a part of the field of vision becomes obscured by a flickering or waving cloud, the edges of which in many persons are sharply defined, serrated, and brilliantly coloured. With an intelligent patient, there could be no difficulty in dis- tinguishing between the momentary obscuration of the whole visual field of one eye which characterises the cardiac cases, and the gradual though rapid flickering or quivering cloud, beginning at one spot and spreading in the course of minutes over something like half the field of vision, affecting both eyes, and distinguishable even when the eyes are shut, which marks the amblyopia of megrim. But many who are clearly the subjects of megrim amblyopia do not give so de- finite an account as the above, often no doubt because they do not observe well. In such cases, the differential diagnosis may be difficult,