A case of unilateral annular scleritis / by D. B. St. John Roosa ; with a report of the pathological examination by Edward L. Oatman.

  • Roosa, D. B. St. John (Daniel Bennett St. John), 1838-1908.
Date:
[1905]
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Credit: A case of unilateral annular scleritis / by D. B. St. John Roosa ; with a report of the pathological examination by Edward L. Oatman. 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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    the existing blood vessels. Apparently the cells first appear in the walls of the vessels, preferably the veins. From the focus thus established the surrounding connective tissue is replaced by round cells (Fig. 4.) It is assumed that the cells are of connective tissue origin and result from proliferation of the fixed connective tissue of the parts. The subconjunctival lymph spaces are greatly dilated. Cel- lular deposits are especially numerous around blood vessels situated immediately beneath the conjunctival epithelium (Fig. 5). This peculiarity was observed in Shirmer's case. In the case tmder examination the pathological changes ob- served in nerves distributed to the affected region are of the highest interest, strongly suggesting that this case of scleritis may be a reflex or trophic disturbance. In the scleral de- posits and subconjunctival tissue, the nerves are in an ad- vanced stage of proliferative interstitial neuritis. There is enormous thickening of the nerve sheath and hyperplasia of neuroglia tissue. Nerves are foimd in which axis cylinders and medullary sheaths have entirely disappeared; being re- placed by fibrous tissue (Fig. 6). The ^cornea is invaded first in its external layers. The epithelium is edematous and its anatomical arrangement disturbed. Bowman's membrane is split and indistinguishable from other disintegrating corneal fibres (Fig. 7). The iris and ciliary body are moderately atrophic and edema- tous. It is probable that the atrophy represents iridocyclitis of the low grade common to chronic glaucoma, while the edema is of more recent origin, resulting from obstructed ciliary circulation. Round cells are not observed in the iris; they are, however, beginning to appear in and around the walls of those vessels in the ciliary body lying nearest the sclera. The anterior chamber is very deep and filled with a slightly fibrinous coagulum containing a few red blood corpuscles. The condition at the filtration angle is a curious feature of the case. The spaces of Fontana contain considerable pigment. They are now open and would undoubtedly allow free passage to normal aqueous. It is, however, apparent that they were formerly obstructed by adhesion of the periphery of the iris to the cornea. This area of old attachment can be traced by the ruptured adhesions and attenuated iris tissue still adherent 1