The relation of ophthalmology to diseases of the nose and its accessory sinuses / by Walter R. Parker.

  • Parker, Walter Robert, 1865-
Date:
[1913]
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Licence: In copyright

Credit: The relation of ophthalmology to diseases of the nose and its accessory sinuses / by Walter R. Parker. 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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    due to vascular changes in the central retinal artery, or toxemia. When one considers the position of the papilloniacular bundle in the nerve and its relation to the central artery, it is difficult to see how pressure symptoms can play so important a part as is often assumed. The macular bundle occupies the peripheral portion of the optic nerve for a distance of about 13 mm. from the globe. It then enters the nerve and soon becomes axial, where it remains throughout the remainder of its course. The central artery enters the nerve at about the point at which the macular fibers begin to enter. At no time are the macular bundle and central artery in intimate relation. Because of the proximity of the sinuses to the orbit, a general toxemia may be overlooked in our desire to establish a direct communication as the course of infec- tion. The character of the infection or lack of resis- tance of the individual to the particular strain may be the cause of the optic nerve involvement, rather than anatomic proximity of the source and dominant symp- toms of the infective process. This belief is substan- ■ -tiated by the statement of Onodi that there seems to be no relation between the sinus involved and the nerve affected. Is it not possible that chronicity rather than the location of the infection has most to do with the possibility of optic-nerve involvement, and that a toxe- mia rather than pressure is responsible for the eye symp- toms? This might explain the oft-quoted saying: The worst sinus cases seem to show the least eye involve- ment. Whatever the source of the eye symptoms may be, some brilliant results have been obtained in retrobulbar neuritis through treatment of the sinuses, and no exam- ination of these cases is complete which does not include that of the rhinologists. The possibility of optic atrophy from posterior eth- moidal suppuration, or from pressure dependent on some sinus involvement, cannot be denied; but to estab- lish a causal relation between the two is most difficult, r have never seen a case of optic atrophy, the origin of which I could prove was due to disease of the sinuses or ethmoidal cells.