Diseases of the eye

Front matter

Glass _ Book-

COPYRIGHT DEPOSIT

BY

Preface To The Sixth Edition

A work which has passed through the press six times in England and six in America has proved its usefulness. In certain points the views and practice of American oph¬ thalmologists differ from those prevailing in Great Britain, hence the publishers have taken the opportunity presented by the exhaustion of another edition to have it revised and adapted even more completely to the needs of American students and practitioners of this branch. They accord¬ ingly desired the present Editor to undertake this task, and to add whatever was necessary to make it a thoroughly up-to-date American text-book.

The book has been completely revised, therefore, partic¬ ular attention being given to the methods of examination usually followed in this country, and a number of thera¬ peutic measures have been added which have recently been largely employed by American ophthalmologists. While the text bearing upon the different diseases of the eye has been altered as little as possible, as it has been this feature of the book particularly which has led to its world-wide popularity, the Editor has introduced into the section on diseases of the conjunctiva the latest views regarding the bacteriological origin of several varieties of conjunctivitis, and has given descriptions of several new forms of ocular diseases.

VI

Preface

A large number of illustrations have been inserted to elucidate the text and to explain the new apparatus which has been described, and the section on the visual tests for railway employes has been thoroughly revised by Dr. Thomson.

In the Appendix will be found the laws governing the visual tests for admission into the public services of the United States. These have been obtained from the author¬ ities at Washington, and are presented for the first time in a collected form, in the hope that they may prove useful to those who conduct the examinations of candidates for the Army, Navy, and Merchant Marine. The methods employed in examining the eyes of school children in certain American cities have also been added.

In conclusion, the Editor desires to express his apprecia¬ tion and thanks to Mr. Nettleship and to Mr. W. T. Holmes Spicer, the reviser of several English editions of the book, for their courtesy and kindness in granting their consent to this American edition.

W. C. P.

OPTICAL OUTLINES.

Lenses and prisms; Refraction of the eye, and conditions of clear vision; Numeration of spectacle lenses; Table show¬ ing the equivalent numbers of lenses made by the inch scale and metrical scale respectively . . . 17—30

Chapter II. External Examination Of The Eye

Examination of: 1. The lids; 2. The conjunctival cul-de-sac;

3. The eyeball; 4. Information derived from the blood¬ vessels visible on the surface of the eyeball; 5. The cor¬ nea; 6. The iris; 7. The pupils; 8. The lens; 9. The mobility of the eyeball; 10. To estimate the tension of the eyeball; 11. Testing the acuteness of sight; 12. Ac¬ commodation; 13. Balance of external eye-muscles; 14.

The ophthalmometer ; 15. The field of vision ; 16. Color perception.37—57

Chapter III. Examination Of The Eye By Artificial Light

1. Focal or “ oblique” illumination.

2. Ophthalmoscopic examination : Use of the ophthalmoscope.

( vii)

CONTENTS.

viii

PAGE

Indirect method : Appearance of optic disk ; scleral ring, phy¬ siological pit, lamina cribrosa; of choroid; of retina; vessels, yellow spot, fovea centralis.

Direct method: Examination of vitreous; Determination of refraction ; Table of relation between refraction and length of eye ; Examination of fine details by direct method.

Retinoscopy.. 58—83

Chapter IV. Diseases Of The Eyelids

Blepharitis; Stye; Meibomian cyst; Horns and warty forma¬ tions ; Molluscum contagiosum ; Xanthelasma ; Pediculus pubis. Ulcers: Rodent cancer; Tertiary syphilis; Tuber¬ cle of conjunctiva; Lupus; Chancre. Congenital ptosis ; Epicantlius; Congenital trichiasis .... 85—93

Chapter V. Diseases Of The Lachrymal Apparatus

Epiphora, stillicidium lachrymarum, and lachrymation.

Epiphora from alterations of punctual and canaliculus; Dacryolitlis.

Diseases of lachrymal sac and nasal duct: Mucocele and lachry¬ mal abscess; Stricture of nasal duct; Lachrymal abscess in newborn infants ....... 94—101

Chapter VI. Diseases Of The Conjunctiva

Purulent and gonorrhoeal ophthalmia; Muco-purulent oph¬ thalmia; Catarrhal and other forms of muco-purulent ophthalmia; Follicular conjunctivitis; Membranous and diphtheritic ophthalmia; Granular ophthalmia; Results of granular ophthalmia; Pannus, distichiasis and trichia-

I

CONTENTS.

sis ; Organic entropion ; Chronic conjunctivitis; Amyloid disease; Spring catarrh ; Conjunctivitis from drugs; Oph¬ thalmia nodosa; Primary shrinking of conjunctiva; Snow-blindness.101—124

Chapter VII. Diseases Of The Cornea

A. Ulcers and non-specific inflammation.

Appearances of the cornea in disease: “Steamy” and “ground-glass” cornea; Infiltration; Swelling; Ulcera¬ tion ; Nebula and leucoma.

Symptoms in ulceration; Photophobia ; Congestion ;

Pain.

Clinical types of ulcer: Simple ulcer; Facetting ulcer; Phlyctenular affections; Phlyctenular, or recurrent vas¬ cular ulcer; Marginal conjunctivitis. (Spring catarrh); Crescentic ulcer of old age; Infective ulcers; Abscess and suppurating ulcer; Hypopyon; Onyx; Keratomalacia; Herpes; Superficial punctate keratitis.

Treatment of ulcers of cornea.

B. Diffuse keratitis.

Syphilitic keratitis. Other affections of the cornea: Keratitis punctata; Corneal changes in glaucoma; Conical cornea; Buphtlialmos (Hydrophthalmos); Calcareous film; Arcus senilis; Inflammatory arcus; Opacity from use of lead lotion; Staining of conjunctiva or cornea from use of nitrate of silver ..... 125—152

Chapter VIII. Diseases Of The Iris

Iritis, symptoms: Muddiness and discoloration of iris; Synechiae; Corneal haze; Ciliary congestion; Pain; Lymph nodules; Hypopyon.

Results of iritis.

Causes: Syphilis; Rheumatism; Gout; Sympathetic disease; Injuries and local causes; Chronic iritis.

Treatment of iritis.

Congenital irideremia; Coloboma; Persistent pupillary mem¬ brane. ......... 153—165

X

CONTENTS.

Chapter IX. Diseases Of The Ciliary Region

PAGE

Episcleritis (or scleritis), sclero-keratitis and allied diseases: Cyclitis (iridochoroiditis, “serous iritis”); Traumatic cyclitis (or panophthalmitis).

Sympathetic affections; Sympathetic irritation; Sympathetic

inflammation; Treatment ..... 166—179

Chapter X. Injuries Of The Eyeball

Contusion and concussion injuries: Rupture of eyeball; Intra¬ ocular hemorrhage; Detachment of iris; Dislocation of lens; Detachment of retina; Rupture of choroid; Paral¬ ysis of iris and ciliary muscle; Iritis; Commotio retinae; Traumatic myopia. Treatment of blows on eye; Dislo¬ cation of lens.

Surface wounds of eyeball: Abrasion and foreign body on cornea; Foreign body on conjunctiva.

Burns and scalds; Prognosis uncertain for some days: Limeburn ; Serious results of severe burns.

Penetrating wounds of eyeball; Slight cases; Severe cases; Traumatic cataract; Cyclitis; Foreign body in eye. Treat¬ ment. Rules as to the excision of wounded eyes. Electro¬ magnet for removing bits of iron.180—190

Chapter XI. Cataract

Senile changes in lens.

Definition of cataract: General cataract: Nuclear and cortical, each may be hard (senile) or soft (juvenile); Congenital. Partial cataract; Lamellar; Pyramidal; Anterior and posterior polar. Cataract following wound or concussion of eyeball.

Primary and secondary cataract.

Symptoms and diagnosis of cataract. Prognosis before and after operation.

CONTENTS.

xi

. . PAGE

Treatment: Palliative; Atropine. Radical; Extraction; Dis¬ cission or solution; Suction.

Rules as to operating for cataract; Artificial ripening of cataract; Causes of failure after extraction ; Hemor¬ rhage; Suppuration of globe; Iritis; Prolapse of Iris; Influence of lachrymal disease.

Sight after removal of cataract.

Treatment of lamellar cataract.

Cataract following injury; Dislocation of lens . 191—212

Chapter XII. Diseases Of The Choroid

Participation by the retina and the vitreous.

Appearance in health ; Appearance in disease: Atrophy, pig¬ ment in choroid and retina ; Exudations, syphilitic, tuber¬ cular; Rupture; “ Colloid ” change ; Hemorrhages.

Clinical forms of disease: Syphilitic choroiditis disseminata; Myopic changes; Central senile choroiditis; Pseudo¬ glioma ; Other forms.

Coloboma; Albinism.213—228

Chapter XIII. Diseases Of The Retina

Appearances in health : Bloodvessels, yellow spot, and “halo” around it; “ Opaque nerve-fibres.”

Appearances in disease: Congestion ; Retinitis, diffuse, localized, with white spots and hemorrhages, solitary patch.

Hemorrhage; Pigmentation ; Atrophy; Disk in atrophy of retina; Detachment.

Clinical forms of disease: Syphilitic retinitis; Albuminuric; Hemorrhagic; Retinitis apoplectica and large single hemorrhages; Embolism and thrombosis; Retinitis pig¬ mentosa ; Retinitis from intense light . . . 229—253

Chapter XIV. Diseases Of The Optic Nerve

Relation between changes at the disk, disease of the optic nerve, and affection of sight.

Pathological changes in optic nerve.

CONTENTS.

• •

Xll

PAGE

Appearances of optic disk in disease: Inflammation, optic neuritis, papillitis, or choked disk; Atrophy after papil¬ litis; Papillo-retinitis.

Etiology of papillitis. Retro-ocular neuritis; Syphilis causing papillitis.

Atrophy of disk: Appearances and causes; Clinical aspects; State of sight, field of vision, and color per¬ ception ; A. Double atrophy; B. Single atrophy . 254—268

CHAPTER XY.

AMBLYOPIA AND FUNCTIONAL DISORDERS OF SIGHT.

“Amblyopia” and “amaurosis:” Single amblyopia: From suppression or congenital defect; From defective images ;

From retro-ocular neuritis. Double amblyopia: Central amblyopia (tobacco amblyopia).

Hemianopia; Hysterical amblyopia and hypercesthesia oculi; Asthenopia

Functional disorders of vision; Endemic nyctalopia; Heme¬ ralopia; Colored vision; Micropsia; Muscse volitantes; Diplopia; Malingering; Color-blindness . . . 269—285

Chapter XVI. Diseases Of The Vitreous Humor

Usually secondary to other disease of eye.

Examination for opacities: Cholesterine; Blood ; Blood¬ vessels in vitreous; Cysticercus.

Conditions causing disease of vitreous: Myopia; Blows and wounds; Spontaneous hemorrhoge; Cvclitis, choroiditis, retinitis; Sympathetic disease ..... 286—290

Chapter XVII. Glaucoma

Primary and secondary.

Primary glaucoma: Premonitory stage ; Chronic or Simple ; Subacute; Acute ; Absolute.

CONTENTS.

PAGE.

Ophthalmoscopic changes ; Clipping of disk.

Symptoms explained; Mechanism.

General and diathetic causes; Treatment; Prognosis Secondary glaucoma; Conditions causing it . . . 291—310

Chapter XVIII. Tumors And New-growths

A. Of the conjunctiva and front of the eyeball. Cauliflower

wart; Lupus; Syphilitictarsitis; Pinguecula; Pterygium; Lymphatic cysts; Dermoid tumor ; Episcleritis simulat¬ ing tumor; Fibro fatty growth; Cystic tumors; Fibrous and Bony tumors ; Epithelioma; Sarcoma.

B. Intraocular tumors. Glioma of retina; Sarcoma of

choroid ; Tubercular tumor of choroid. Tumors of iris : Sarcoma; Sebaceous tumor; Cysts; Granuloma . 311—320

Chapter XIX. Injuries, Diseases, And Tumors Of The Orbit

Contusion and concussion injuries. Emphysema of orbit; Traumatic ptosis.

Abscess and cellulitis of orbit; Inflammation and abscess of lachrymal gland.

Wounds: Of eyelids; of orbit; Large foreign bodies in orbit. Tumors of orbit. General symptoms: Distention of frontal sinus; Ivory exostosis; Tumors growing from parts around the orbit; Pulsating exophthalmos; Cystic tumors; Solid intraorbital tumors. Naevus. Dermoid tumor in eye¬ brow ......... 321—328

Chapter XX. Errors Of Refraction And Accommodation

Emmetropia ; Ametropia.

Myopia. Symptoms: Insufficiency of internal recti. Poste¬ rior staphyloma and crescent; Other complications; Tests for causes; Measurement of degree; Treatment; Spec¬ tacles ; Tenotomy.

Hypermetropia. Symptoms: Accommodative asthenopia; Tests for hypermetropia; Treatment; Spectacles.

XIV

CONTENTS .

PAGE.

Astigmatism. Regular and irregular; Seat; Focal interval; Cylindrical lenses ; Forms of regular astigmatism ; Detec¬ tion and measurement; Spectacles.

Unequal refraction in the two eyes (anisometropia).

Presbyopia: Rate of progress ; Treatment: Range and region

of accommodation in E., M., and H 329—364

Chapter XXI. Strabismus And Paralysis

Definition of strabismus; Diplopia ; True and false image ; Homonymous and crossed diplopia ; Suppression of false image.

Causes: Strabismus from over-action ; from weakness; from disuse; from weakness following tenotomy; from paral¬ ysis.

Paralysis of sixth nerve (external rectus); of fourth nerve (superior oblique); of third nerve; Ophthalmoplegia externa; Primary and secondary strabismus; Giddiness in paralytic strabismus.

Affections of internal muscle of eye: Physiology and action of drugs on the internal muscles; Affections of pupil alone; of accommodation alone ; of pupil and accommo¬ dation ; Ophthalmoplegia interna.

Causes of external ocular paralyses: Syphilitic growths; Meningitis ; Tumors ; Rheumatism ; Causes of internal ocular paralyses; Treatment.

Chapter XXII. Operations

A. On the eyelids.

Epilation ; Eversion of lid ; Meibomian cyst; Inspection of cornea; Spasmodic entropion; Organic entropion and trichiasis ; Ectropion ; Blepliaroplasty ; Ptosis; Canthoplasty ; Peritomy ; Symblepharon.

B. On the lachrymal apparatus.

Lachrymal abscess; Slitting canaliculus; Stricture of nasal duct, (1) probing, ^2) incising, ( 3) syringing.

CONTENTS.

xv

PACE.

C For strabismus.

Tenotomy: Graefe’s; Critchett’s; Liebreich’s; Readjust¬ ment and advancement.

D. Excision of the eye and alternative operations: Abscission,

optico-ciliary neurotomy, evisceration.

E. On the cornea.

Foreign body ; Paracentesis ; Corneal section for ulcer ; Conical cornea.

F. On the iris.

Iridectomy : For artificial pupil ; for glaucoma. Iridodesis; Iridotomy (iritomy).

Sclerotomy.

G. For cataract.

Extraction: Linear ; Graefe’s “modified linear Short flap ; Corneal section; Old flap; Complication during extraction ; Treatment after extraction ; Secondary opera¬ tions ; Discission or solution ; Suction; Treatment after solution and suction.

Anaesthesia in ophthalmic surgery . . . 393—445

Chapter XXIII

A. GENERAL DISEASES.

Eye diseases caused by: Syphilis, acquired and inherited, dis¬ eases of optic nerve and oculomotor nerves in relation to syphilis; Smallpox, scarlet fever, typhus, etc.; diphtheria; Measles ; Mumps ; Chicken-pox and whooping-cough ; Malarial fevers ; Relapsing fever; Epidemic cerebro¬ spinal meningitis; Purpura and scurvy; Pyaemia and Septicaemia ; Lead-poisoning ; Alcohol; Tobacco ; Bisul¬ phide of carbon ; Quinine ; Kidney disease ; Diabetes; Leucocythaemia; Pernicious anaemia; Heart disease ; Tuberculosis ; Rheumatism and gonorrhoeal rheumatism;

Gout, personal and inherited ; Struma; Entozoa.

XVI

CONTENTS.

B. LOCAL DISEASE AT A DISTANCE FROM THE EYE.

PAGE

Eye symptoms caused by: Megrim ; Neuralgia and sympathetic disease; Diseases of brain; Cerebral tumor; Syphilitic disease; Meningitis; Cerebritis; Hydrocephalus; Diseases of spinal cord; Myelitis; Locomotor ataxy; General par¬ alysis of insane; Lateral and insular sclerosis; Motor disorders of eyes and affections of the pupils in cerebral and spinal disease.

C. THE EYE SHARING IN A LOCAL DISEASE OF THE

NEIGHBORING PARTS.

Eye symptoms caused by: Herpes zoster of fifth nerve; Para¬ lysis of fifth, of facial, and of cervical sympathetic nerves; Exophthalmic goitre; erysipelas and orbital cellulitis.

The teeth in inherited syphilis . 447-478

[SUPPLEMENT.

Instructions for examination of railway employes as to vision, color-blindness, and hearing; Acuteness of vision; Range of vision ; Field of vision ; Color-sense ; Hearing ; Ex¬ planations . 479-511]

Appendix

Formulae.513

Bandages. Shades. Protective glass.526

Test types, etc..529

Ophthalmoscopes.530

Perimeters. 533

Requirements of candidates for public services . . . 536

Method of examining the eyes of scholars in the public schools 539

Part I. Means Of Diagnosis

The following abbreviations will be used in this work:

Acc.

Accommodation.

P-

Punctum proximum, •

As.

Astigmatism.

or near point.

Ax.

Axis of cylindrical

Pr.

Presbyopia.

lenses.

r.

Punctum remotissi-

B.

Base of prism.

sum,or far point.

C. or Cv

mi

. Cylindrical lens.

S. or

Sph.

Spherical lenses.

D.

Dioptre.

T.

Tension; Tn, normal

E.

Emmetropia.

tension; + T,

IT.

Hypermetropia.

increased, and

m.

Metre; cm. centime-

— T, dimintre; mm. milliislied tension.

metre.

Y.

Visual acuity.

M.

Myopia.

y. s.

Yellow spot of the

Optic disc.

retina.

CHAPTER