Selected monographs.

  • New Sydenham Society.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    172/372 (page 158)
    The patient affirms that his sight is good in the two eyes dur- ing the attack, but that during the period which follows, and whilst the fingers return progressively to their normal colour, the sight, especially that of the left eye, becomes troubled and confused, recovering at the moment when a new attack super- venes. He has used for four years a No. 16 convex. It was of the greatest interest to see if the ophthalmoscopic examination would give the explanation of this singular pheno- menon of intermittent amblyopia. It was to be presumed a priori that this would depend on disturbances of the circulation in the fundus of the eye. The result of this examination was as follows: the pupil was dilated by atropine. When the left eye (the worse of the two) was examined during a period of reac- tion—that is to say, when the cyanotic colour of the extremities was at its minimum—we saw that the central artery of the retina, and the arteries which proceeded from it, presented in all their extent very clear contours; further, we established very definitely that they were narrower in their commencement near the papilla than at the periphery. Here and there we observed a sort of partial strangulation. The papilla itself was of a very clear tint. The veins were the seat of extremely remarkable pulsations. We know that pulsation of the central vein of the retina is a pheno- menon which is frequently observed in the normal state, and that one can bring it about at will by exercising a gentle pressure upon the globe of the eye; but this physiological pulsation is limited to a very small area at the point of entrance of the vein into the non-transparent parts of the optic nerve. Here we have to do with something quite different; the pulsations are remark- able for an intensity and an extent altogether unusual. They are a little later than the radial pulse. At each pulsation we see the central vein not only dilate and deepen in colour, but elongate itself very notably in the region of its origin in the papilla, so as to simulate a small aneurysm by its expansion in every direction. The pulsation extends well beyond the limits of the papilla. It can be observed in at least three vessels simultaneously, and in almost all the venous capillaries. The right eye (the less affected) presented analogous phenomena, but in less degree. The narrowness of the arteries was certainly less marked than in the left, and the relative diminution of the central artery in relation to its branches less appreciable.