Glaucoma / by Priestley Smith.

  • Smith, Priestley.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: Glaucoma / by Priestley Smith. 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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    Simultaneously with the occurrence of these obstructions the anterior chamber usually decreases somewhat in depth, and in some cases becomes extremely shallow. This is, at first sight, difficult to reconcile with the indubitable turgescence of the ciliary processes, for these organs lie in front of the suspensory ligament^ and any increase of their dimensions must tend, per se^ to displace the lens backwards, whereas what actually happens is that the lens advances and the processes are squeezed, sometimes into a remarkable wedge-like form, between it and the iris {vide Fig. 131). It is clear that the intra-ocular fluid collects in excessive quantity in the vitreous chamber and expands it at fhe expense of the aqueous chamber. The probable explanation of its doing so is to be found in the altered relations of the ciliary processes; posteriorly they are still free to unload them- selves if they can into the vitreous body, but anteriorly a large portion of their secreting surface is tightly pressed between the lens and iris; and in addition to this, the outlet of the vitreous chamber, the circum- lental space, is closed so that the surplus vitreous fluid can no longer pass forward in- to the aqueous cham- ber as in health. In the chronic^ non- irritative form of pri- mary glaucoma the obstructive changes which have just been described come about very gradually. Clini- cally we see that there is little vascular dis- turbance, and that the relationship to senility is an almost invariable one. In this form of the disease it appears probable that the narrowing of the circumlental space depends rather upon a structural disproportion between the size of the lens and its surroundings, than upon any morbid turgescence of the processes {;vide Note at end of Chapter, p. 652). The circumlental space is reduced by slow degrees, the ciliary processes undergo no considerable swelling, and, unless some auxiliary cause should supervene to induce hypersemia and turgescence, a long period may elapse before the angle of the anterior chamber becomes completely closed and impermeable. In acute glaucoma, on the other hand, the vascular disturbance is great. The outbreak of the attack commonly follows close upon some emotional, Fig, 131. From a Specimen of recent Acute Glaucoma, at Age 74. Showing margin of lens in contact with swollen ciliary processes; angle of anterior chamber closed by pressure of processes against iris. (The same condition exists at other parts of the circle. The lens was broken in dissection.) {^Enlarged 10 diameters.)