A manual and atlas of medical ophthalmoscopy.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1890
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Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy. 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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    ohoroid. An example of it in slight degree is fignred in Fig. 68, which shows that the pigment-epithelium may be detached with the retina. Hcemorrhage into the vitreous occasionally occurs from the rupture of an extensive extravasation in the superficial layers of the retina. It is always single, and may occur, as in a case under my observation, without the patient’s knowledge. One day the fundus was distinct, and vision good; the next nothing hut a black reflection from the interior of the eyeball could be seen, and sight was lost. It is hardly necessary to say that damage to vision may be permanent. It may probably occasionally determine glaucoma. Embolism is said to be an occasional complication of albu- minuric retinitis (Yoelcker). But this statement must be accepted with considerable reserve. Embolism elsewhere is extremely rare. Thrombosis sometimes occurs in the cerebral arteries, and the signs of embolism may have been due to that cause, and on the other hand the contraction of the retinal arteries may simulate that in embolism ; but there is no corresponding defect of the field of vision in these cases, such as would certainly have been present if embolism or thrombosis existed. As I have suggested, the explanation of these appearances which seems most probable is that the tendency to arterial contraction, which is often traceable in normal arteries in tliis disease, leads to an extreme degree of narrowing when the changes in the disc lessen the flow of blood into the arteries. Course.—In most cases the retinal changes persist, some lessening, others increasin^g, until the patient’s death. Not rarely, however, they diminish notably, and the retrogression may proceed until the changes almost or quite disappear. This is especially the case when the affection comes on in the course of the chronic kidney disease which results from an acute attack, in which considerable improvement in the renal affection is often obtained, and in other chronic cases when prompt treatment soon after the onset of the retinal disease can improve the action of the kidneys. The effect of pm’gation in lessening the retinal affections has been often observed, and