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"Until you obtained the remedy?" "Probably for always. One must not let glaucoma run or it becomes chronic. It's God's own luck that I have this stuff with me it's the pilocarpin I told you of. The other stuff atropin would blind me for sure!" He thrust forward the three bottles. "Here," he urged. "If you had not the remedy this what-you-call pilocarpin, what would you do?"
The enlargement of the anterior perforating veins is an old symptom of chronic glaucoma. Obstruction to outflow of blood through the vorticose veins, by the increased intra-ocular pressure, has long been a recognized explanation of the malignant tendency of glaucoma a part of the vicious circle established in this disease.
Capillary blood pressure must lie between the arterial blood pressure and the venous blood pressure. It must be closely associated with the nutritional processes like secretion or inflammation; beyond this we know little about it. The association of increased blood pressure with glaucoma seems to be generally an indirect one through vascular lesions and disturbances of nutrition.
The first type brings us near to what may be the essential nature of glaucoma, impairment of ocular nutrition by the intra-ocular tension, which is generally elevated, but may not be above the usual normal. A special weakness in the nutrition of nerve tissue may be assumed. It would help to explain the cavernous atrophy of the optic nerve associated with simple glaucoma.
A careful examination of each tooth together with radiograms of the entire maxilla are absolutely essential to determine their presence or absence. Trephining for Glaucoma London, England. Mr. President and Members of The Chicago Ophthalmological Society: As the hour is late I propose to take up only the principal points in connection with my subject and to deal with each one shortly.
I am firmly convinced that every glaucomatous patient, and I now refer to those who are the subjects of chronic progressive glaucoma, should be carefully studied from the general standpoint by the oculist with the aid of an expert internist, just as I am convinced that the modern expert internist should not study his cases of cardio-vascular disease without the help of the oculist.
According to the edema theory advanced by Fischer, glaucoma is "essentially an edema of the eyeball, and for its production we must hold responsible the same circumstances which are responsible for a state of edema in any other part of the body."
For nine years I have watched the progress of such a glaucoma in a man now aged 87, with slow development of glaucomatous cupping of the optic disc, now more than 3 D. deep. Similar cases in which the tension lay within the commonly accepted normal limits have been reported recently by Bietti and Stock.
Characteristically, he forgot utterly the night of the full moon! First of all, it was evident that he must turn back if he was to save his eyesight. As he remembered glaucoma, it ought to be surgically treated within two months, at most. The second point was whether he could turn back. His mission was a simple one. Would it wait? He could not see why not.
I believed from the title that there might be a wide divergence of opinion between us. I find to my great relief that we are in absolute accord. I know, however, that there are in America and elsewhere able men who consider that the medical treatment of glaucoma should be pushed as long as possible.
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