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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    the lens, suspensory ligament, ciliary processes, and iris, a thick septum cemented together by old inflammatory exudation; and we find a quantity of blood poured out into the posterior part of the globe. In such an eye the secretory function of the ciliary processes has long ceased, and the channel which normally conducts the intra-ocular fluid from the vitreous chamber no longer exists; hence the non-removal of the effused blood, the absence of any rapid compensation for its presence, and the high tension. Prompt excision of the eye is advisable. Haemorrhage into the anterior chamber will sometimes, in like manner, set up a high degree of tension. This is little likely to occur when an incision in the cornea, as after the operation of iridectomy, provides a channel for the speedy escape of the blood. It happens sometimes when the anterior chamber fills with blood as the result of an injury without penetration. It is more especially apt to ensue in eyes in which, from previous disease, the outlet of the chamber is already closed by compression, or impervious through long disuse. I have specimens of secondary glaucoma in which the angle of the anterior chamber is completely blocked with blood. Of more practical interest are those cases in which a deep-seated haemorrhage in a previously sound eye is followed at once, or within a short space of time, by an attack which resembles acute primary glaucoma. When, by reason of the senile reduction of the circumlental space, an eye is already prone to become glaucomatous on the occurrence of even a small rise of vitreous pressure, it is conceivable that the mere addition of a small quantity of blood to the contents of the vitreous chamber might start the malady. In some instances, however, the extravasated blood acts in a more direct fashion ; for in two of my specimens it has blockaded the circumlental space by entering and passing round the canal of Petit, thus establishing an obstruction similar in its effect to that which has been assigned as the starting-i^oint of primary glaucoma, but one which, unlike a simple nar- rowing of the circumlental space from swelling of the processes, would not be relieved by iridectomy. Serous iritis is usually associated with an exalted tension. This form of glaucoma differs from almost every other in that the anterior chamber deepens as the pressure rises, showing that the surplus fluid is collecting in the aqueous and not in the vitreous chamber. The retrocession of the iris renders it unlikely that any compression of its periphery is present during the glaucomatous attack, and in a specimen of serous iritis in my possession the angle of the anterior chamber is not only uncompressed, but distended far more widely than in Ae healthy eye (Fig. 139). For this specimen also I am indebted to Prof. McHardy. It is probable that the morbid constitution of the aqueous humour is the source of a retarded filtration in these cases. Serous iritis is characterized by the deposit of numerous small coagulated masses upon the posterior surface of the cornea, which, when very abundant, _lead to parenchymatous inflam- mation and sclerosis of the corneal tissue itself They settle by gravi- tation chiefly upon the lower half of the cornea. It is highly probable that