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But it may become suddenly worse, or go on to complete blindness with pain, demanding enucleation, after some temporary perturbation, as the performance of a glaucoma operation. It is pre-eminently the kind of a case you would prefer would go to some one else. Each of these types illustrate a distinct cause or group of causes.
The following hypothesis is based upon Fischer's edema theory of glaucoma and the relation of the circulation of the eye and orbit and that of the nose and the accessory sinuses, the minute anatomy of which is not as yet thoroughly understood.
Treacher Collins found, after a careful examination of eyes upon which iridectomy had been performed for glaucoma, that it is extremely rare for the initial section to pass through the pectinate ligament, while Schlemm's canal invariably escapes.
The third group are cases associated with glaucoma only as causes. In eyes with low nutritive power, or subject to exacerbations of increased intra-ocular pressure, uveal inflammations may prove disastrous.
More definite knowledge of the nervous mechanism concerned in the regulation of intra-ocular pressure and the production of glaucoma is much needed. Alterations of Fluids and Tissues The influence of increased affinity of the tissues for fluid has already been referred to.
Perhaps we may reach that happy day when, especially with improved tonometric methods, increased skill in measuring the rate of filtration and better instruments for determining the light sense, we can anticipate the advent of glaucoma and get ahead of the ocular and visual deterioration which increased tension produces, by performing preventive operations which shall aid nature's filtration channels in the establishment of an artificial one.
It is convenient to start with the conception that glaucoma is increased tension of the eyeball, plus the causes and effects of such increase; although a broad survey of the facts may reveal a clinical entity to be called glaucoma, without increased tension constantly or necessarily present, and cases of increased intra-ocular tension not to be classed as glaucoma.
This work has been so slightly related to practical ophthalmology, and so contradictory in its results that alterations in the fluids can only be regarded as a possible etiologic factor. Glaucoma secondary to intra-ocular hemorrhage, operations on the lens or its capsule, or severe nutritional disturbance may be capable of such explanation. Different Kinds of Glaucoma
That of an elderly patient with marked vascular disease, often renal involvement, and distinctly impaired nutrition. There may be renal retinitis or retinal hemorrhages. The case may easily become one of hemorrhagic glaucoma. It may run a very chronic course.
His next step was to acquaint himself with the nature of the affliction on account of which he was to destroy himself. At the public library he collected a half-dozen books treating of blindness, and selected his particular malady. He picked out glaucoma, and for his purpose it was admirably suited.
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