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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    applied to the cornea by pressure from behind. * One case has been placed on record in support of the explanation here given, in which no rise of tension occurred until, by the use of eserine, the iris was contracted and tightened up against the posterior surface of the lens, when an acute glaucomatous condition at once supervened, f The case is all the more noteworthy as a proof of the mechanical causation of the glaucoma, for eserine has a precisely opposite effect upon the tension where the relation of the parts concerned is different—it reduces the tension of primary glaucoma. Further, the case suggests the practical lesson that if eserine be employed as a preliminary to the removal of the lens from the anterior chamber, its use should be begun but a very short time before the operation. Lateral dislocation of the lens by injury is not unfrequently followed by a rise of tension. This condition also I have lately been able to study both in the living eye and afterwards under the microscope. The angle Fig. 137. From a Specimen of Secondary Glaucoma induced by Lateral Dislocation of the Lens. {^Enlarged 5 Diameters.) of the chamber was firmly closed throughout • that part of the circle towards which the lens was displaced, by the direct pressure of the margin of the lens against the ciliary processes (Fig. 137). { A glance at the normal relations of these parts, in the senile eye especially {vide Fig. 128), will show how readily such pressure may be set up by a slight tilting or lateral displacement of the lens. Several years ago I had under notice the case of an elderly man with traumatic lateral dislocation of the lens, in which the glaucomatous tension subsided as soon as the pupil was well dilated by atropine, and the detached margin of the lens freely exposed in the area of the pupil; returned in full intensity when the pupil again contracted; and again disappeared under the use of atropine. It seems not unlikely that the enlargement of the pupil permitted some slight alteration in the position of the lens which relieved * Ophth. Review, Vol. I., p. 209. t J. J. Minor, New York Medical Journal, i88i, p. 194. X Ophth. Review, Vol. II. p. 257.