Two cases of Raynaud's disease with ocular symptoms : one case complicated by scleroderma / by George Howard Fox.

  • Fox, Howard, 1873-1947.
Date:
1907
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Licence: In copyright

Credit: Two cases of Raynaud's disease with ocular symptoms : one case complicated by scleroderma / by George Howard Fox. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    elbow and forearm. The patient herself shows no evidence whatever of any former syphilitic infection. Examination of the patient’s only child, a boy of nine years, fails to show any stigmata of heredi- tary syphilis. A symptom of considerable importance that occurred in this as well as in my second case was sudden paroxysmal impairment of vision. I regret to say that it was not possible in either case to wit- ness a spasm of the retinal vessels such as Raynaud and others have described. It was difficult to control my first patient, and I never succeeded in having an ophthalmoscopic examination made during one of her visual spasms. The second case had not exhibited any visual disturbances since she came under my observation, and an ophthalmoscopic examination kindly made for me by Dr. H. W. Wooton showed, as was expected, a normal fundus. In a small number only of cases of Raynaud’s disease have similar visual disturbances been described. In two of Raynaud’s cases such symptoms occurred. In his first case the ophthalmoscope showed a distinct narrowing of the central arter}”^ of the retina. This did not coincide with the spasm of “ local asphyxia ” in the fingers, but ap- peared as they were returning to their normal color. Marked pulsa- tion of the veins was also noted. In Ra^maud’s second case, the contraction of the retinal artery and the resulting obscuration of vision coincided with the onset of cyanosis in the fingers. | Local asphyxia and visual disturbances were combined in three ^ cases reported by Calmette and quoted by Munro. In two cases there | was narrowing of the papillary arteries, and in the third venous pul- i sation. All three patients had suffered from malaria. In Moriez’s i case the right fundus was pale, the vessels hardly visible and the ‘ papilla indistinctly limited. Narrowing of the retinal vessels was , also observed in the unusual cases described bj Weiss. In Bland’s case, that of a maniac who would expose himself to cold by remaining out of bed, there were dimness of vision and inability to read. The ophthalmoscope showed the fundus to be unusually pale, the vessels blanched, and “ almost indistinct.” In the case recorded by Mor- gan there was considerable narrowing of the arteries of the retina, although not paroxysmal in character. In Stevenson’s case there were attacks of sudden complete loss of vision, not long enough, ho^^- ever, to admit of ophthalmoscopic examination. Another point of interest in my first case was the involvement of so many regions, including the fingers, toes, nose, eais, cheeks, chin, tip of the tongue, and nipples.