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Updated: May 11, 2025
This does not for a moment mean that prior, for example, to operative work it is not necessary to get rid by means of drugs of an over plus tension, for surely the elimination of such an over plus tension may be the means of preventing, for example, an intra-ocular hemorrhage, and in this emergency we must not lose sight of Gilbert's recent investigation, who has found that blood withdrawn to the extent of 8 grams to each kilogram of the body weight always produces lowering of the intra-ocular tension, appearing in six to eight hours and lasting to the next day in simple glaucoma, and in inflammatory glaucoma commencing the day after the venesection and lasting two to three days.
The second type shows impairment of the regulative mechanism permitting rapid rise of the intra-ocular pressure. In persons of good nerve nutrition and strong recuperative power, it may exist for years without doing permanent damage. But joined to causes of the first type, lowered nutritive activity, it causes rapid and permanent loss of sight.
This over plus amount may be in association with a rise of intra-ocular pressure, and must be eliminated if the latter is to be controlled by a non-operative procedure, or, indeed, by an operative one.
This method of treating increased intra-ocular tension, introduced, as you know, by Thomas and Fischer, has met with confirmation from a number of sources in spite of the fact that Happe's experimental study failed to confirm Fischer's observations; indeed, he even reports in several instances a rise of tension.
Upon incision of the prolapse intra-ocular hemorrhage occurred, causing nearly total blindness for two weeks. Vision is clearing fast and it remains yet to be seen what the final results may be. One buphthalmic eye trephined by myself gave good results.
A month later the tension rose to 28 mm., but for a year has continued normal; the eye did well under tuberculin treatment, and without any local treatment. In September of this year I had two cases of iritis in which the intra-ocular tension rose to 45 and 52 mm., respectively, and gradually returned to normal, with the cure of the iritis under atropine.
Hence the suggested association of the dental surgeon with the ophthalmologist in these cases of apparently idiopathic increased intra-ocular tension. It would be well to state here a cursory examination of the mouth will not discover root abscesses any more than such examination will discover non-suppurative sinus disease.
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.
Domec uses an elliptical eye cup, the concave margins of which fit closely about the globe. The air is exhausted with each respiration of the patient and from 50 to 200 tractions are made at each sitting. Domec is of the opinion that this method succeeds in two ways, namely, in producing analgesia by traction on the ciliary nerves, and in reducing intra-ocular tension.
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.
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