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I shall not quote Hare's elaborate methods for determining these various points because they do not belong to a paper of this character, but I quote his admirable advice because it emphasizes what I believe to be an essential in the treatment of chronic glaucoma, exclusive of operative work, that is, the intelligent co-operation of the oculist and the internist.
The exciting cause is vascular, maintained and influenced by the general circulatory pressure. A rise of the general vascular tension alone will not cause glaucoma, because any alteration in intra-ocular pressure resulting would be purely a temporary change, easily taken care of by the extensive access of aqueous to the intra-ocular venous system.
He could fairly hear the slow, impressive voice. "There is one symptom," the past was saying to him, "one symptom, young gentlemen, that is not always present; but when present establishes the diagnosis beyond any doubt. I refer to a peculiar hardening of the eyeball itself " "Glaucoma!" cried Kingozi aloud. His thoughts, like hounds on a trail, raced off after this new scent.
Very deep anterior chamber may occur in glaucoma, due to retraction of lens and iris following fibrinous or plastic exudation into the vitreous, or when it occurs in congenital glaucoma, due to enlargement of the globe. Aqueous Humor. The aqueous humor becomes slightly turbid in acute attacks, coagulating more readily than the normal.
There seems little doubt that Truc and Imbert's observations that high frequency currents can temporarily reduce intra-ocular tension is correct, that they are able to relieve the pain of primary and of secondary glaucoma would seem to be proved by many observations, some of which I have myself made, and other very accurate and excellent ones have been made by Risley in Philadelphia.
We are all familiar with the attention which was directed some years ago to the statements coming from French clinics that the treatment of glaucoma should include the administration of osmotic substances as adjuvants in the reduction of increased intra-ocular tension.
"Hahnloser and Sidler: One hundred seventy-two eyes observed not less than ten years after operation; acute inflammatory, 31 eyes; good results, 64 per cent; relatively good, 13 per cent; blind 23 per cent; chronic inflammatory, 37 eyes; good result, 29.9 per cent; relatively good, 27 per cent; blind, 43 per cent; simple glaucoma, 76 eyes; good results, 42 per cent; relatively good, 28.9 per cent; blind, 28.9 per cent."
When these two factors coexist in their varying combinations, pathological increase of pressure results in short, glaucoma. Syphilis, rheumatism, gout, auto-intoxication and many other constitutional disorders are well recognized agencies which induce sclerosis in body tissues, so there can be little doubt that these conditions produce pathological sclerosis of the meshwork of the iris angle.
Complete interruption of the nutritional stream would be speedy death; partial interruption may be held responsible for most of the visual impairment and pain of glaucoma. The balance of intra-ocular pressure is not maintained by the slight distensibility of the sclero-corneal coat.
Obstructed Outflow A reservoir with a free outlet can only fill during a flood; and then quickly empties itself again. The outflow channels in the normal eye provide for carrying away of the waste products of such an active nutrition, that it is hard to think they will become inadequate in glaucoma until there has been a marked decrease from their normal capacity.
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