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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    forehead and the temple; the conjunctiva is injected; the anterior ciliary vessels are engorged and tortuous; the pupil is unusually large and sluggish, and the anterior chamber shallow; and, on attempting to view the fundus of the eye with the ophthalmoscope during such an attack, we observe some impairment of the normal transparency of the cornea. Each recurrence tends to intensify the mischief and to render the subsequent remission less complete, and by degrees the glaucomatous condition becomes permanently established. The tension remains persistently in excess; excavation of the optic disc, and permanent contraction of the visual field begin. The course of the malady is still marked by periods of exacerbation, between which months may elapse, and during the quiescent intervals the eye may exhibit only such symptoms as are met with in the earliest stages of chronic glaucoma. On the other hand, the attacks may recur from day to day, and rapidly produce destructive changes. The more acute symptoms tend to become persistent; the enlargement and tortuosity of the episcleral vessels increase; the pupil remains large and fixed, in shape frequently oval rather than round; the tissue of the iris atrophies; the disc is deeply excavated with extensive destruction of its nerve fibres; pain is frequent and severe; and sooner or later the day arrives when sight, long since limited to a small central area of the retina, is totally extinguished. Acute Glaucoma is distinguished from the varieties already described by the suddenness of its onset, the intensity of all its symptoms, and its little tendency to spontaneous remission. While chronic glaucoma is liable to be mistaken for simple atrophy of the optic nerve, acute glaucoma simu- lates a general inflammation of the eyeball. The resemblance, although only superficial, has led too often to disastrous results. It cannot be too forcibly reiterated that the whole malady depends upon excessive pressure within the eyeball; we have here to deal with no true inflammation, and cannot cure the disease by any antiphlogistic measures; a lowering of the pressure, and that only, can break the chain of evil consequences. The attack is in many cases preceded, or ushered in, by a premonitory stage such as has been described under the heading of sub-acute glaucoma; in other instances it comes on without warning of any kind in an eye which, so far as the patient can tell, has previously been free from all disorder. The premonitory stage is less frequently absent in the younger than in the older class of sufferers. The immediate exciting causes of the outbreak, as in the case of the milder attacks of sub-acute glaucoma, include various forms of nervous excitement and exhaustion, such as grief, anger, anxiety, sleeplessness, etc. ; they include, also, all conditions which tend to promote venous engorgement in the head and eye. Many of these are usually associated with more or less dilatation of the pupil; and here again it must be noted that, when the predisposing conditions (pp. 603-4) are present, an acute glaucoma of great severity may be lighted up simply by dilating the pupil with atropine.