The diagnosis and treatment of the diseases of the eye

Front matter

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Preface

Several editions of a smaller work on Diseases of the Eye having been received with steadily increasing favor, the author ventures to offer to the Profession another contribution to its literature, which he hopes may be acceptable and useful.

In carefully preparing this new treatise, in which he has sought to embody that which his own observation and the recorded experience of others has proved to be of most value, the author has kept always in view his original purpose, and has endeavored to make his book a Practical Guide, serviceable to the general practitioner and to students. His aim has been to describe clearly and accurately, but at the same time as simply and concisely as possible, the nature and the cause of diseased processes in the various parts of the eye ; to define the normal conditions, and to show the most important variations, of its optical functions of refraction and accommodation ; to explain the ophthalmoscope, and the modern methods of exploration, which have so greatly increased our knowledge of the changes occurring in the internal structures of the eyeball ; and to indicate modes of treatment promising the best results.

Too elaborately scientific descriptions and statements of theories have been for the most part avoided ; as tending to yi PREFACE.

encumber the work rather than to aid those whom it has been the author's earnest wish to assist.

To Dr. Charles H. Williams the author is indebted for valuable suggestions and assistance in carrying the book through the press.

15 Aklington Street, Boston, November 1, 1881.

TABLE OF CONTENTS,

Chapter I. Method Of Examining The Eye

Position of the patient neai* a window, 1. — General inspection, 2. — Mobility of pupil, 3. — Tension of globe, 3. — Lateral illnminatiou, 5. — Use of atropia, 6. — Detection of cataract, 6. — Eversions of upper lid, 7. — Examination of children, 8. — Differences of injection, 9 ; of secretion, 9; of pain, 9. — Perception of light, 10. — Duration of morbid conditions, 10. — Evidences of other disease, 11. — Limitation of visual field, 11. — The ophtlialmoscope, 13 ; its advantages for general diagnosis, 13 ; as a means of illumination of deeper parts of the eye, 13 ; for measuring refractive conditions, 32. — Principle of the ophthalmoscope, 14; methods of exploration, 17; direct or upright method, 17; indirect or inverted image, 20. — Positioii for ophthalmoscopic examination, 19. — Ius|jection of cornea, lens, and vitreous, 24 ; of optic disc, 24 ; of other parts of fundus, 25. — Liebreich's and Loring's ophthalmoscopes, 27, 29. — Appearance of optic disc, 29, 228 ; of macula lutea, 31 ; of choroid, 31.

Chapter II. Remedial Means

Local and general remedies, 34. — Reserve in using potent applications, 35

Solutions a preferable form, 35. — Crayons, 36. — Depletion, 36. — Counter irritation and poultices to be avoided, 36.

Chapter III. Traumatic Injuries

Contusions, 37. — Injuries of conjunctiva : from wounds, 37 ; from caustics or burns, 38 ; from foreign bodies, 39. — Injuries of sclera : from wounds, 39 ; from rupture, 39. — Injuries of cornea: from foreign bodies, 40, 44 ; from abrasions, 43 ; from wounds, 45. — Injuries of iris, from foreign bodies, 46. — Sympathetic iritis, 47. — Hernia of iris, 47. — Injuries of choroid, from rupture, as result of a blow, 47. — Traumatic cataract, 48. — Separation of retina, 37, 223.

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Chapter IV. Affections' Of The Conjunctiva

Anatomy, 51. — Hypertemia: simple conjunctivitis, 52. ^— Chemosis, 54. — Ecchymosis, .54. — Pinguecula, 55. — Dermoid tumor, 55. — Encysted tumor, 55. — Malignant growths, 55. — Pterygium, 56. — Syphilitic disease, 57. — Phlyctenular conjimctivitis, 57. — Muco-purulent conjunctivitis, 59; catarrhal, 60 ; lachrymal, 67 ; from presence of foreign bodies, 67; after use of atropia, 68; exanthematous, 68. — Purulent conjunctivitis, 68. — Gonorrhoea! conjunctivitis, 73. — Follicular conjunctivitis, 77. — Granular conjunctivitis : trachoma, 78. — Panuus, 80. — Membranous conjunctivitis, 86 — Diphtheritic conjunctivitis, 86. — Conjunctivitis of new-born children : ophthalmia neonatorum, 88 ; dangers of neglect, 88, 91.

Chapter V. Affections Of The Sclera

Anatomy, 95. — Scleritis, 96. — Staphyloma, 98. — Posterior staphyloma, 99. ' CHAPTER VI.

AFFECTIONS OF THE CORNEA.

Anatomy, 100. — Phlyctenular keratitis, 101. — Bulla3, 103. — Ulcer: in children, 104; in adults, 110; post- variolous, 110; paralytic, 110 ; from ectropiuin, 111; from debilit;y, 112; creeping, 112 ; after cerebro-spinal meningitis, 113. — Herpes zoster ophthalmicus, 113. — Conical cornea, 115. — Anterior hydrophthalmia, 118. — Staphyloma, 118. — Arciis senilis, 122. — Interstitial keratitis, 122. — Infiltration and ulceration, 126. — Fistula, 129. — Opacities, 130. — Tumors, 133.

Chapter VII. Affections Of The Iris

Anatomy, 135. — Coloboma, 136. — Iritis: rheumatic, 137; syphilitic, 149; serous, 151. — Importance of dilatation of the pupil, 143. — Hernia, 151. — Infantile syphilitic iritis, 153. — Irido-choroiditis, 153; sympathetic, 153, 156. — Enucleation or enervation of the globe to prevent sympathetic ophthalmia, 160-165. — Cysts of iris, 165. — Malignant tumors, 166. — Discolorations, 166. — Mydriasis, dilatation of pupil, 166. — Myosis, contraction of pupil, 169. — Irregular movements, 1C9. — Operations on iris: iridectomy, 171; iridotomy, 172; iridodesis, 173.

Chapter VIII. Affections Of The Choroid

Anatomy of choroid and ciliary body, 174. — Suppurative choroiditis, 177. — Post- febrile ophthalmitis, 179. — Puerperal ophthalmitis, 179. — Dissemi-

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nated choroiditis, 180. — Hcemorrhage in choroid, 182. — Osseous change in choroid, 183. — Tumors, 184. — Operation for enucleation, 185; for enervation, 161. — Coloboma, 187. — Absence of pigment, 188. — Sclero-choroiditis posterior, 188.

Chapter IX. Glaucoma

Causes, 191. — Tension of globe, 191, 196. — Manner of attack, 192. — Ophthalmoscopic appearances, 193. — Cupping of optic disc, 193. — Limitation of visual field, 192, 194. — Premonitory symptoms, 193, 194, 195. — Glaucoma simplex, 195 ; chronic, 195 ; acute, 195. — Changes in cornea and crystalline, 196. — Nausea and vomiting as concomitant symptoms, 197. — Remissions uf attacks, 197. — Usual time of invasion, 198. — Absolute glaucoma : a hopeless condition, 198. — Glaucoma fulminans, 198. — Causes and treatment^ 198. — Surgical means the sole resource, 199. — Iridectomy, 199; must be done promptly, 200 ; method of doing, 203. — Sclerotomy, 207. — Warning to friends of patient, 202.

Chapter X

Anatomy of the retina and optic nerve, 208. — Hypersemia, 210. — Apoplexy, 211. — Embolism of arteria centralis, 212. — Hypertesthesia, 214; hysterical, 214. — Retinitis, 216; nephritic, albuminuric, 217; leucocythajmic, 220; syphilitic, 220; pigmentosa, 221. — Separation of retina, 223. — Sunblinding, 227. — Sunstroke, 227. — Tumors, 227. — Ophthalmoscopic appearances of optic disc, 228.

Chapter XI. Affections Of The Optic Nerve

Neuritis, 230. — Choked disc, 231 . — Chronic neuritis, 233. — Anajmia of optic disc, 234. — Atrophy, 234. — Tumors of optic nerve, 236.

Chapter XII. Amaurotic And Amblyopic Affections

Amaurosis : gutta serena, definition of, 237 ; complete, 237 ; partial, 237 ; various causes of, 238 ; cerebral, 238 ; spinal, 238 ; changes of pupil in, 238 ; limitations of field of vision, 238. — Amblyopia, causes of, 239. — Hemeralopia : in retinitis pigmentosa, 241 ; idiopathic, causes of, 241 ; simulation of, 242. — Feigned blindness, 242. — Artificial mydriasis, 242. — Reflex blindness, 2J3.

Chapter XIII. Color-blindness

Usually congenital and incurable, 245. — May occur after disease, 245. — Very rarely affects females, 245. — Is a disability for employments on railways and ships where colored signals are used, 245. — Modes of detecting, 247. — Acuteness of vision and of hearing should also be tested, 249.

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Chapter XIV. Affections Of The Crystalline

Anomalies and displacements, 250. — Cataract : senile, 252 ; incipient, mode of detecting, 252 ; nuclear, 252 ; cortical, 252 ; development of, 253. — False cataract, 255. — Congenital cataract, 258 ; often hereditary, 260; a cause of nystagmus, 260 ; should be operated on early, 260. — Soft cataract in adult*, 260 ; fluid, 260 ; traumatic, 48, 260 ; diabetic, 260 ; secondary, 261 ; cretaceous, 261 ; glaucomatous, 262. — Pyramidal cataract, 262. — Capsular, 262. — Secondary capsular cataract, 263. — Operations for cataract, 263 ; by displacement, 266; by extraction, 267. — Flap extraction, 268; combined with iridectomy, 274 ; with outscooping, 275. — Peripheral linear extraction, 275. — Median flap extraction, 278. — Extraction of lens in its capsule, 281. — Suture of cornea after extraction, 282. — Soft cataract : linear extraction, 283 ;

• discision, 284 ; suction, 287. — Secondary operations upon crystalline capsule, 288. — Removal of secondary degenerated cataract, 292. — Extraction of a dislocated lens, — 293.

Chapter XV. Affections Of The Vitreous

Hyalitis, 295. — Softening, 295, 298. — Phlegmonous degeneration, 295. — Opacities: fixed, 295 ; floating, 295; temporary, 295. — MuscEe volitantes, 297. — Crystals, 298. — Cysticerci, 298.

Chapter XVI. Affections Of The Motor Muscles

Action of these muscles, 301 • — Paralj'sis, 303. — Paresis, 304. — Paralysis : of central origin, 307; periphei'al, 307; of abducens, .S08 ; of oculo-motorius, 309 ; of the patheticus, 310. — Ptosis, 311. — Paralysis of the orbicularis palpebrarum, 312. — Nystagmus, 313. — Insufficiency of the recti intcrni, 314. — Strabismus, 317 ; convergent, 322 ; divergent, 328. — Reattachment of s. muscle to the globe, 330. — Deviation after cerebral apoplexy, 332.

Chapter XVII. Refraction And Accommodation

Emmctropia, 334. — Accommodation : power of, 337 ; mechanism of, 338, 344 ; measure of, 343. — Acuteness of vision, 347. — Defects of the eye as an organ of vision, 348. — Asthenopia, 349. — Presbyopia, or old sight, 351. — Spectacles or eye-glasses, 356. — Test glasses-, 359.

Chapter XVIII. Ametropia

Anomalies of refraction, 361 ; determination of, with the ophthalmoscope, 363.

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Chapter XIX. Myopia

Conditions of myopia, or short-sightedness, 366 ; change of form of the globe in, 368 ; incurability of, 368 ; hereditary disposition to, 368 ; structural changes in, 370 ; a disease of civilized nations, 369 ; increase during school and college life, 372 ; progressive tendency of, 372 ; disposition to strabismus, 377. — Choice of glasses in myopia, 379.

Chapter XX. Hype Kmetropi A

Depends on a shortened antero-posterior axis of the eye, 383 ; is a congenital condition, and often hereditary, 385 ; not dangerous to vision, as is myopia, 385 ; requires convex glasses for its relief, 385 ; is a frequent cause of convergent strabismus, 387 ; choice of glasses in, 386, 389.

Chapter XXI. Astigmatism

Regular, depends on difference of refraction in two meridians of the cornea, 391 ; irregular, caused by abnormal position, structure, or curvature of the crystalline, 391. — If regular, may be relieved by cylindrical glasses, 392.

Chapter XXII. Test Letters And Likes

Employed to determine acuteness of vision, myopia, hyperopia, and astigmatism, 398. — Choice of glasses whei'e the crystalline has been removed, 398 ; aphakia, 399.

Chapter XXIII. Anomalies Op Accommodation

Paralysis of accommodation, 401. — Is generally associated with mydriasis, 401. — Sometimes a symptom of cerebral lesion, 401. — Spasm of accommodation, 402. — Caused by overwork or reflex irritation, 402. — Is one of the signs of locomotor ataxia, 402. — May be artificially excited by use of myotics, 402.

Chapter XXIV. Ophthalmitis

Inflammation of the whole globe may occur in a disorganized eye if it receives a blow, 404 ; or may follow operations,- 404 ; or be caused by presence of a foreign body in the deep parts of the eye, 404 ; or may happen, in rare cases, from embolism in puerperal or febrile conditions, 404. — Inflammation of Tenon's capsule, 405. — Has much resemblance to ophthalmitis in symptoms, 406. — Generally results in loss of vision, with partial atrophy of globe, 406.

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Chapter XXV. Diseases Of The Orbit

Orbital tumors, 407. — Tumors of the optic nerve, 408. — Cystic tumors, 408. Entozoa, 408. — Aneurismal enlar'^ements, 408. — Disease of lachrymal gland, 408. — Fibrous growths, 409. — Malignant growths, 409. — Osseous formations, 409. — Fatty tumors, 409. — Haemorrhage in orbit, 410. — Abscess, 411. — Diseases of the antrum, 412. — Tumoi's of the frontal sinus, 413. — Anasmic exophthalmos, Basedow's disease, 413.

Chapter XXVI. Artificial Eyes

Must be carefully chosen, 417. — Mode of insertion and removal, 418. CHAPTER XXVII,

AFFECTIONS OF THE LACHRYMAL ORGANS.

Anatomy, 420. — Epiphora, 421. — Displacement or closure of the lachrymal puncta, 421. — luflammation of the lachrymal sac, 422. — Fistula lachrymalis, 423. — Obstruction of the lachrymal duct, 425. — Probes for removing stricture, 42.5.