Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot.

  • Elliot, Robert Henry, 1864-1936.
Date:
1914
Catalogue details

Licence: In copyright

Credit: Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    205/222 (page 183)
    of glaucoma cases and has pondered over their almost endless variety, has probably come to the certain conclusion, that whilst the term glaucoma is a very convenient label for a huge mass of cases, which all have the common feature of a rise of intra-ocular tension, the causes which bring about this rise in tension are many and various. The stormy course of the affection, once the rise in tension has become established, serves to monopolise the surgeon's attention, distracting it from this very important aspect of the ■case. If a simile may be permitted, it would be that of a man standing by the bank of a narrow cataractous river, which is fed by a number of broad slowly-moving streams. The tossing, turbid, tumultuous torrent impresses his imagination far more than the quiet channels; and he leaves with the lasting impression of rushing waters predominant in his mind, to the exclusion of any thought of the very streams on which the torrent depends. Is not this the position, even now, of many who are engaged in the treatment of glaucomatous patients ? Are we not apt to forget the aetiological side of our cases in the absorbing interest of the momentous factor of increased tension ? Priestley Smith has set us an inspiring -example, and others have followed in his footsteps; but we are still groping in semi-darkness. One important element in the situation is that of intra-ocular sepsis. We use the term in its largest possible meaning, and have been led to make this observation from a clinical study of the very class of cases we are now considering. Two explanations may be offered of the continuance or increase of intra-ocular conges- tion after an operation for glaucoma. It may be due (1) to the continuance of a septic action which was in existence before we operated, or (2) to an accidental infection at the time of operation. The subject is a difficult one and requires careful study, but will well repay the pains spent on it. To begin with, the usual course ot a case of congestive glaucoma, after successful trephining, is that the signs of congestion rapidly subside, and the eye returns quickly to its condition of health. This is obviously what should happen if the main trouble is a condition of intra-ocular congestion brought about by a rise in the tension of the eye, for by lowering that tension, we have removed the cause of the congestion. When this happy result is not attained, we are justified in concluding that another factor has complicated the problem, and that factor often is, in our opinion, some form of sepsis. The really important point, to which we now come, is the source of this sepsis. Has it been introduced by the surgeon, or was it there before he stepped in at all ? Is he to blame for it, or is it merely a