Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson.

  • Robertson, J. Argyll.
Date:
1844
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Licence: Public Domain Mark

Credit: Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson. 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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    the appearance of being augmented in bulk. The sclerotic coat is by no means disposed to yield to distention, but readily gives way by absorption, as Ave daily see occurring in various dropsical affections of the eye. The tumour now projects from the eyeball either through the sclerotic in the neighbourhood of the cornea, where it is thinnest and most readily yields to absorption, in which case it retains for a time a conjunctival covering, or the cornea inflames and sloughs or ulcerates, and thus afl:brds room for the further in- crease of the diseased mass. The tumour, now no longer confined by the membranes of the eye, enlarges rapidly, and projects from between the swollen eyehds upon the cheek. (Fig. 13.) In texture it is soft, spongy, and easily lacerated. Being supplied freely with blood-vessels, the coats of which are extremely delicate and readily ruptured, the tumour not only usually assumes a dark hue from blood effused into its texture, but profuse hemorrhage ensues from spontaneous rupture of these vessels, or on the application of the shghtest mechanical irritation. Coagula of blood are often found in the interior of the mass. As the dis- ease progresses, parts of the tumour slough, others ulcerate, and the patient sinks exhausted by suffering, discharge, and bleeding. Occasionally he is carried off by a sudden profuse hemorrhage. In some instances during the progress of the disease the absorb- ent glands over the parotid and those of the neck swell, and in them a similar medullary matter is deposited. Tumours of the same character are not unfrequently found in other parts of the body, more especially in the viscera of the abdomen and thorax. An appearance in the eye dependent on a totally different cause, but resembling medullary carcinoma in its early stage, is occasionally met with. It is when either pure blood or fibrine is effused from the arteria centralis retinas into the cells of the hyaloid membrane. When blood is effused, it presents at first, when viewed in a clear light, a bright scarlet hue ; but in propor- tion as the colouring matter of the blood is absorbed, it exliibits the peculiar metallic glistening appearance which is seen in the mahgnant disease. This effusion of blood into the vitreous humour may occur spontaneously, or be the result of external injury. The red colour presented in the early stage, and the sudden occurrence of the affection, will point out the difference between it and the malignant tumour. It is more diflScult to lorm a diagnosis between cases of effusion of fibrine into the hyaloid membrane, and the malignant tumour. In the instances of effusion of fibrine which I have witnessed, the metallic lustre, which must arise from the presence of an opaque reflecting substance deeply seated in the eye, was not so clearly marked as in the malignant disease, probably owing to the effu- sion being in the substance of and not posterior to the vitreous