Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot.

  • Elliot, Robert Henry, 1864-1936.
Date:
[1913?]
Catalogue details

Licence: In copyright

Credit: Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot. 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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    to take place in vessels and nerves, the dilatation of the pupil and atrophy of the iris may be absent. Looking at the question from a clinical point of view, it appears to us that this explanation hardly covers the ground. The iris muscle gives every evidence of being atrophic, and the atrophy has apparently progressed pari passu with the crushing of the nerve filaments. Unless fibrous tissue replaces the constrictor muscle of the iris before the nerves become paralysed, it is difficult to explain the inactive and relatively contracted pupil we are discussing. It is hard to believe that the nerve filaments can retain their vitality in one of these stony eyes, however gradually the pressure may be applied. We meet with another form of clinical aberration of no less interest than the preceding one, although far rarer. From time to time a patient presents himself with all the outward signs of high tension. The tonometer confirms the diagnosis in an unmistakable manner, and yet there is not a sign of cupping of the disc. In the absence of pathological investigation, one can only conclude that the region of entry of the optic nerve is not the weakest part of the ocular tunic in such an eye. The real interest of the observation lies in the fact that in these cases we must act upon the indications of the tonometer and not on those of the ophthalmoscope. Fortunately it is but very seldom that our allegiance to the latter instrument is thus rudely shaken. Ophthalmoscopy.—A typical case of glaucomatous cupping is so characteristic, as to need no comment in a work like this. The whole disc is thrust bodily backward, and the vessels as they curl round its edge to appear at the fundus level, appear to lie on the retina from their first point of emergence onwards. Anyone who has made a large.number of ophthalmoscopic examinations in glaucoma, must be familiar with another type of appearance in which a varying width of the centre of the disc is punched backward, whilst the remaining and not inconsiderable portion of its periphery retains for a time at least the level of the surrounding fundus. The kink in the vessels is typical. The cupping affects all meridians equally, and vascular pulsation may be, and often is, marked. The condition is quite unlike that of physiological excavation of the disc, though it imitates the appearance of a partial coloboma. The symptoms of glaucoma are, however, tvpical. We have been able to follow several of these cases after trephining, and to note a marked atrophy of the depressed portion of the disc which followed even when the operation had relieved tension, brought back vision, and to some extent restored the fields to their former dimensions.