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)

    244/384 (page 234)
    *234 MEDICAL OPHTHALMOSCOPY. the conditions which obtain in the larger arteries pass on, so to speak, into the smaller vessels, and even overcome the regulating influences of the eye (see p. 20). In one case described, the existenee of the valvular lesion was first •suspected from this pulsation. For the above-mentioned reasons, neither simple dilatation nOT simple hypertrophy of the left side of the heart usually ^ects the size of, or circulation within, the retinal vessels. -Dilatation only acts when it involves the right side of the heart in an extreme degree, and then may cause some venous ■congestion. But hypertrophy, when its cause is such as per- mits it to act on the smaller vessels, may produce, although rarely, retinal haemorrhages. It is doubtful whether it is capable of doing this unless rupture be permitted by vascular degeneration. The haemorrhages which result may lead to degenerative white spots, which may persist after the dis- appearance of the effused blood. Thrombosis of the central vein occurs in rare cases of heart disease, mitral and aortic (see p. 30). Emhohsm of the central artery of the retina is an occasional consec[uence of valvular disease of the heart, and is probably the most common cause of amaurosis associated with cardiac disease—a coincidence which was first noted by Seidl and Kanka in 1846.i Its occurrence is governed by the same conditions as those which determine it elsewhere. It is most common in mitral disease, especially, like cerebral emhohsm, in mitral constriction. Its signs have been already described <p. 33). Transient failure of sight without ophthalmoscoj)ic changes is common in heart disease, and may he unilateral and con- siderable. To the latter form attention has been lately called by Nettleship.2 Malignant Endocarditis.—In the rare form of “ ulcerative endocarditis ” attended with fever and pysemic symptoms ■(which Litten better designates “ malignant endocarditis ”), —the “ diphtheritic endocarditis ” of some Grerman writers, ^ Canstatt’s “ Jahresb.,” 1846, iii. 115.