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A better grasp of the etiology of glaucoma may be attained by considering separately various types of cases; although perfectly typical cases may be rare; and cases of mixed type and etiology much more frequent. Simple glaucoma has been recognized as closely related to atrophy of the optic nerve with deep excavation.
Concerning Non-Surgical Measures for the Reduction of Increased Intra-ocular Tension Philadelphia. Only a few years ago the literature of glaucoma was big with discussions of the comparative value of the surgical and non-surgical treatment of glaucoma, and especially of the chronic types of this disease.
This blocking of the angle of the anterior chamber must be regarded as an established fact in the etiology of glaucoma. But because it is so definitely established, and because so much work has been done with reference to it, we may attach to it an undue importance. The escape of the outflow of fluid from the eye is ultimately through the veins.
We believed that the best results were obtained in a seance of two or three minutes, the finger tip being used over the lid, and the surface of the cornea lubricated with a drop of pure olive oil, although in glaucoma the addition of the oil is not necessary.
The physiologic tension of the eyeball is essential to ocular refraction, and closely related to ocular nutrition. Fully to understand the mechanism for its regulation would carry us far toward an understanding of the causes of glaucoma. Normal tension is maintained with a continuous flow of fluid into the eye and a corresponding outflow.
Forty per cent of existing blindness, and a vast amount of physical degeneracy, is the direct result of venereal causes. Certain forms of glaucoma may be inherited, and children whose parents have had this disease should watch their own eyes very carefully, since, if taken in time, the progress of this disease, in certain forms, may be arrested.
Eventually the ciliary body becomes very much reduced in thickness, is flattened out, the ciliary processes reduced in size and the blood vessels disappear or are reduced much in caliber. Those that persist possess walls that are much thickened. This is particularly true of hemorrhagic glaucoma.
Only such eyes as have high hypertony, for example, in absolute glaucoma, are unaffected during chloroform narcosis.
It is, moreover, much safer than any other operation I know of, and is no less certain in its results. I do not advise trephining in the secondary glaucoma following intumescent cataract, for in such cases the semi-fluid lens bulges into and blocks the trephine hole.
First: The operation of trephining is suitable, not merely for chronic cases, but for sub-acute and acute cases of glaucoma as well. I would urge on your attention that, of all the operations dealing with glaucoma, this one involves the minimum of surgical violence, and should, therefore, in acute cases be the operation of choice.
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