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Usually each movement occupied from a half to one minute, according to the results desired. I agree with Casey Wood that such a technic furnishes just as good results as any one with the aid of an instrument. Referring particularly to the reduction of intra-ocular tension, many surgeons have been impressed with the value of various instruments.
Moreover, in chronic glaucoma the ordinary inflammatory processes are not present, indeed, primary acute glaucoma itself is not an inflammation. I have no personal experience in the use of the constant current with negative pole application to the eye in the reduction of increased intra-ocular tension, but quote for our general benefit the opinions of those who have employed it.
Obstruction to the steady escape of the intra-ocular fluids at any point in this drainage system or any undue increase of the fluids themselves may produce glaucoma. Probably the most important obstruction to the exosmosis is at the angle close to Schlemm's canal."
These facts and deductions have given rise to the present day circulatory theory of intra-ocular pressure, so we now can approach the predisposing and exciting factors which determine glaucoma. The central fact to be borne in mind is, if the physiological pressure is vascular in origin and nature, the pathological pressure must likewise be derived from the same source.
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.
This operation opens a large filtration passage for the intra-ocular fluids and the prompt healing of the wound with its mucous covering prevents prolapse of the iris. Under no circumstances must iris be left between the lips of the wound.
In some experimental work the primary elevation of intra-ocular tension was followed by a secondary drop. Indirect reduction of increased intra-ocular tension brought about by lowering general vascular pressure. Much has been written in regard to the association between increased vascular pressure and increased intra-ocular pressure.
He brings together many facts to support the view that in the living tissues impaired circulation, and especially diminished oxidation, are the chief causes of increased affinity of the colloids for water. Such affinity increased by the impairment of the intra-ocular circulation, may well constitute a factor making for malignancy in glaucoma.
The normal intra-ocular pressure is uninfluenced by myotics because this pressure represents the lowest circulatory pressure in the eye, and further contact between aqueous and veins cannot reduce it below this level, another point which is made by Thomas Henderson in support of his contention.
Wood's system of therapeutics gives rise to an hypothesis as to why disease of the nasal accessory sinuses may be a factor in producing increased intra-ocular tension and why treatment directed toward obtaining free drainage from the sinuses gives good results in so many cases, especially if the relationship is recognized sufficiently early.
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