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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    number of tributarj'’ veins, should be noted in connection with the apparent size of the vessels. There is one point, however, which does possess indirect medical significance. The general arrangement of the vessels in the two eyes is usually similar. Moreover, similarity in vascular arrange- ment may be inherited. I have seen, for instance, a peculiarity in the course of the retinal vessels in a mother exactly reproduced in the ej^e of her daughter. This is a striking proof of the transmission of vascular arrangement in general; upon this depends the vascular strain, and, in part at least, the occimrence and locality of vascular degene- ration, and even of vascular rupture. Thus, inspection of the retinal vessels suggests to us one way in which a tendency to cerebral haemorrhage, or softening from atheroma, may be inherited. Course.—The course of the retinal vessels usually pre- sents few tortuosities, and those which exist are lateral, in the plane of the retina. A considerable increase in tortuosity may be associated with a naevus of the adjacent pari- of the skin.^ The arteries are rather more tortuous in hypermetropic eyes than in others. When the vessels are elongated by their distension or atony, these lateral curves are exaggerated. Antero-posterior curves, at right angles to the plane of the retina, are indicated by the change in the central reflection abeady mentioned, by the relative displace- ment of parts at different levels on movements of the ob- server’s head, and sometimes by slight obscuration of the vessel at the lowest point of the curve. They always indi- cate iiTegularities in the retina in which the vessels lie, commonly swelling, as in retinitis and retinal oedema. Structural Changes.—Most changes in the tissue of the retinal vessels are visible only to the direct method of examination. The commonest change is an increase in the ^ See Allen Sturge in “ Clin. Soc. Trans.,” vol. xii. 1879, p. 162. For cases of idiopathic tortuosity of retinal vessels, chiefly affecting the veins, see Benson, “Trans. Ophth. Soc.,” vol. ii. p. 55; Nettleship, ibid. p. 57; Stephen Mackenzie, ibid. vol. iii. p. 101 ; all with accompanying drawings.