SYPHILITIC AFFECTIONS OF THE EYE AND THE ORBIT.
As already described, many expressions of the various stages of syphilis pertain to the eye. Thus there may be chancre upon the eyelid or conjunctiva, or ulceration of the same; syphilitic iritis as a secondary expression; syphilitic retinitis, neuroretinitis, choroiditis, as tertiary lesions; and the formation of gummas in the later stages of the disease, and in almost any imaginable locality, especially the uveal tract. Syphilitic tumors are seen upon the iris more often than anywhere else within the eye. Outside of the globe and within the orbit the ordinary expressions of syphilitic periostitis and of gummatous tumors occur. These constitute also the more common intra-orbital expressions of this disease.
The symptoms of syphilitic lesions in this location do not vary from similar lesions elsewhere, save so far as they involve special tissues or disturb the special sense of sight. The prognosis in nearly all of them is relatively good if suitable and active treatment be promptly instituted. It is, however, too much to expect that annular destruction of areas of the retina or choroid can be completely repaired.
CATARACT.
Cataract is a subject of primary interest to the general surgeon only so far as it pertains to the consequences of injury to the orbital region. The term implies opacity of the lens or of its capsule, or both, which may be partial or complete. Its pathognomonic feature is slow and progressive failure of vision. Examination by direct as well as bilateral illumination will show the opacity to be located behind the iris. Everyone should be able to recognize it; its excision should be relegated to the trained specialist, since it is one of the most delicate special operations.
GLAUCOMA.
The term glaucoma implies a collection of more or less variable pathological conditions within the eyeball which lead to increased intra-ocular tension. Because of this increased pressure, with its disturbance of circulation and the peculiar coloration often given to the cornea or the pupil, the disease has received this name. Among its symptoms are pupillary changes, including both size and mobility of the iris; turbidity of the cornea, as well as the fluid humors of the eye; pain, corneal anesthesia, impairment or final loss of vision, engorgement of the visible vessels of the globe, and a peculiar cupping or excavation of the optic disk. Unless checked by operative intervention the course of the disease is steadily toward blindness. It varies in acuteness, the favorable cases being the acute ones, in which early operation can be practised. It admits of no other treatment.
Treatment.
—The operation almost universally practised by the oculist is either iridectomy or sclerotomy. The condition is briefly mentioned in this place for the double reason that the student may be made aware that the condition may follow certain injuries to the eyeball or the head, and that the more chronic forms have been successfully treated by excision of the cervical sympathetic, on one side or both, the operation being based upon anatomical and physiological facts pertaining to the distribution and function of those sympathetic fibers which pass to the orbit from the cervical trunk. The operation is described in the section on the Cranial and Cervical Nerves.