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In acute glaucoma such massage is not available, but it is of assistance in encouraging a reduction of the intra-ocular tension and keeping it at a normal grade after operative work, particularly after a filtering cicatrix has been made, as was well shown by Weeks in his study of glaucomatous eyes operated upon by the Lagrange method.
In the light of this observation it will be interesting to measure the tension both of normal and glaucomatous eyes during narcosis in a large series of cases, and if it is confirmed there will be an additional reason why in many circumstances general narcosis is advantageous in glaucomatous patients.
Toczyski's experiments with this drug on the normal eye indicate that it produces first a rise of tension, which shortly falls to the normal and sometimes below it, the tension being high as long as the primary narrowing of the pupil is maintained, but more than one author, particularly A. Senn, holds an opposite view and reports acute glaucoma following its instillation into a chronic glaucomatous eye.
This much seems to be established: First, that at corresponding ages there is usually a higher average blood pressure in glaucomatous subjects than there is in non-glaucomatous subjects; second, that arteriosclerosis and therefore usually increased blood pressure, with all its concomitant conditions, is correctly classified as an exciting cause of glaucoma; and third, that the regulation of this increased blood pressure is part of the advantageous management of increased intra-ocular pressure, although it may be too much to say, as Gilbert has, that blood pressure and intra-ocular pressure rise and fall together.
In most instances the successful maintenance of a glaucomatous life, exclusive of operative interference, in addition to sustained myosis, demands the investigation of the patient's metabolism, which must be kept at the normal standard, the removal of the evil effects of auto-infection, as we are wont to call it, and especially the elimination of the cause which is responsible for the over plus tension of the arteries and of the veins.
Atrophy and cystic degeneration of the nerve trunk follows destruction of retinal neurons and cupping of the disc. Neuroglia remains in part. Connective tissue elements increase in the optic nerve as the nerve fibers disappear. Glaucomatous Ring.
This permits the sclera to show through a very little at this part. In some eyes in which there is a beginning sclero-chorioiditis posterior, the condition is very similar to that presented by the glaucomatous ring. Field of Vision. The two pathological processes that operate to destroy the function of the retina suffice to produce scotomata in the field of vision of varying shapes.
The typical glaucomatous field in the acute cases shows a defect most pronounced to the nasal side. The field in a simple glaucoma is apt to approach concentric limitation; namely, more like the field in simple atrophy. This is consistent with the fact that simple glaucoma in many cases possesses the characteristics of glaucoma plus atrophy of the optic nerve. Vitreous.
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