A case of sudden monocular amaurosis, presenting unusual difficulties in diagnosis.

  • Sands, Henry B. (Henry Berton), 1830-1888.
Date:
[1866]
Catalogue details

Licence: Public Domain Mark

Credit: A case of sudden monocular amaurosis, presenting unusual difficulties in diagnosis. 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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    Perception of light almost entirely absent, although patient can just discern the concentrated light thrown into the eye by means of the ophthalmoscope; tension normal. Ophthalmoscopic Examination, 12, M., five hours after the attack. Right eye, normal. Left eye, media transparent; branches of central artery very small, being scarcely traceable beyond the papilla; veins hardly, if at all, diminished in size; at centre of macula lutea a circular disk, of a deep red color, sharply outlined, having about one-third the diameter of the optic papilla; the latter very pale and anaemic, contrasting strongly with that of the healthy eye; between the optic pa- pilla and the macula lutea another deep red spot, resembling the first, but of nearly double the size, and having an irregu- larly oval shape, the long diameter situated in the horizontal median plane. The appearances thus described were also seen by my friends, Drs. Noyes and Altliof. Careful auscultation of the chest failed to discover the least sign of cardiac disease, the presence of which, indeed, there was no good reason to suspect. The patient was directed to remain quiet, in a dark room, and to have six leeches applied to the left temple. At 7 p.m. I saw him again, in consultation with Prof. Schweigger, of Berlin. Meanwhile, and, according to the patient's statement, before the application of the leeches, a decided improvement in vision had taken place, and he was able to count fingers at 2' in several parts of the visual field. The latter, however, showed various interruptions, and central vision was absent. Ophthalmoscopic examination: Arterial vessels of the retina restored to their natural size; veins slightly turgid; retina gray and cloudy, especially around the macula lutea, where the red spot formerly mentioned still ex- ists. The larger red spot near the nerve also remains the same. Patient ordered to have the eyes bandaged. Nov. 15. Hardly any change. The visual field exhibits, beside other interruptions, a large central scotoma, about 7 in diameter, at P from the eye. Latterly, patient counts fin- gers at 3', except when held above and to the right side. Ophthalmoscopic appearances nearly the same. The whole retina, however, is more decidedly cloudy, and conceals the choroid from view. The cloudiness is most marked in the