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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    have been recorded in foreign journals, in which the diagnosis of embolus was pretty clearly made out. The symptoms of the disease are tolerably uniform. Sudden blindness, with sub- jective luminous sensations, announce the invasion of the dis- order. At this period, on ophthalmoscopic examination, the media are found to be transparent, the optic papilla pale, and both the arteries and veins of the retina reduced to an extreme degree of tenuity. After the lapse of some days or weeks, the vessels may partially regain their previous size, especially towards the periphery, probably from the development of a col- lateral circulation. The retina exhibits an opalescent opacity, especially near and at the macula lutea, the centre of which, however, is usually marked by a deep red spot, which, by some observers, is looked upon as an extravasation of blood, while by others it is ascribed to the natural color of the choroid, seen through the retinal substance (which, in this situation, is exceedingly thin), and contrasting with the grayish opacity of the surrounding infiltrated retinal tissue. The final result is usually atrophy of the optic nerve and retina, with nearly total loss of sight; and when vision is partially restored, it is gen- erally limited to the eccentric parts of the visual field. Now, in the case I have recited, although many of the symp- toms above mentioned were present, I think we must reject the diagnosis of embolus for the following reasons: 1st. The ab- sence of any evidence of cardiac disease. This alone, how- ever, would not be decisive, provided all the other symptoms were present. 2d, and principally, because the phenomena of the retinal circulation, as revealed by the ophthalmoscope, cannot be reconciled with the theory of complete and perma- nent arterial obstruction, such as would be caused by an em- bolus. In every reported example of this affection, it has been noticed that both the arteries and the veins of the retina were greatly reduced in size. This is what we should expect, a priori, seeing that an embolus, while it would prevent the blood from entering the central artery and its branches, would in no way interfere with the return of the blood through the veins, which would, consequently, also be empty. But in the present case, the arterial branches alone were anaemic, while the veins were filled with blood. Furthermore, if the two red