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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    That there should be wide variations in the experience of different observers is not to be wondered at when one considers the relation of the optic nerve as given by Onodi. He says: The optic nerve may come in relation with the sphenoidal sinus or ethmoidal cells, and the wall of the sphenoid may be very thick. The variation in thickness ranges between 1 and 12 mm. It is evident that even destruction of bone may occur in accessory sinuses and yet no visual disturbance result. While there is no form of visual field contraction which can be considered pathognomonic, there is scarcely any variation in the field that may not be produced by disease of the eye secondary to accessory sinus infection. The most common deviation from the normal occurs in cases of retrobulbar neuritis in irregular central scoto- mas with or without ophthalmoscopic findings. The attempt to establish a diagnosis of the sinus involved by the quadrant of the field affected has not been success- fully established. That there is no uniformity of opin- ion in this whole subject is shown by the opposing state- ments of such men as Birch-Hirschfeld and Onodi. Birch-Hirschfeld asserts that central scotoma is an early and important symptom of tumor or suppuration in the posterior sinuses, due to damage to the papillomacular bundle, while Onodi has observed the absence of these phenomena in similar cases and also in one case of sar- coma filling up the nasal cavity. He also asserts that the visual fields are not narrowed in cases of ethmoidal cell suppuration. The more one studies clinical peri- metry, the more one hesitates to base any diagnosis on the field findings alone. The enlargement of the physiologic blind spot has received much attention recently as of diagnostic value in retrobulbar neuritis, but as yet our knowledge of the normal limits of the blind spot is too vague to warrant definite conclusions. . While paralysis of the extrinsic ocular muscles is ol exceedingly rare occurrence in sinus involvement, paretic conditions may complicate mild cases of sinusitis, and become manifest as an insufficiency of one or more oi the ocular muscles. The muscle itself or the nerve upplying it may become involved. The function o the Zde may be but slightly interfered with, and diplopia