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Updated: May 11, 2025
The increase of intra-ocular pressure noted in cases of uveal inflammation, to be presently referred to, may be due to some such tendency. But it is rational to ascribe to obstruction of the filtration angle of the anterior chamber, the important part it has been supposed to play in the pathology of glaucoma.
The efficacy of the operation in lowering intra-ocular tension is to some extent measured by the degree and the constancy of this epibulbar oedema; indeed, I suspect that the most successful examples are those in which sclera fistulae, minute or otherwise, form as a sequel of the operation.
Such a conception, while not strictly in accord with recognized physiological teachings, proves that the normal intra-ocular pressure is not a question of volume content, but that it is purely a question of pressure of a fixed volume within an unyielding capsule. Dr.
The form of the scar was described in most instances, but it was not noticed that there was a definite relation between the cicatrical formation and the intra-ocular tension. In 70 per cent of the cases a good result followed the operation, but in 10 per cent the result was decidedly unsatisfactory.
Glaucoma is probably not so much an increase of tension as a loss of balance between intra-ocular tension and nutritional activity. In contrast with the above are the cases marked by sudden elevations of ocular tension recurring repeatedly over long periods without permanent visual impairment.
Applying these conclusions to the eye, it can be said that the pressure of the fixed intra-ocular volume varies with the venous tension within the bulb, which in turn is influenced by the general circulation.
The exciting cause is vascular, maintained and influenced by the general circulatory pressure. A rise of the general vascular tension alone will not cause glaucoma, because any alteration in intra-ocular pressure resulting would be purely a temporary change, easily taken care of by the extensive access of aqueous to the intra-ocular venous system.
It is interesting to remember that Paul Knapp, in the course of this investigation, observed reduction of the tension after the use of holocain. Another method of reducing the intra-ocular tension is by the suction method, which consists in the use of certain cups from which the air is exhausted by means of a suction apparatus.
This, as you know, consists in applying the thumb to the cornea through the closed lids, and making repeated pressures upon it at the rate or 60 to 100 a minute. He checked his results with the tonometer after 200, 500 and 1,000 pressures, and found that even in normal eyeballs such massage was followed by a fall of intra-ocular tension, the average being nearly 9 mm. after a thousand pressures.
George Edmund de Schweinitz' Paper on Concerning Non-Surgical Measures for the Reduction of Increased Intra-ocular Tension Discussion, Milwaukee. It seems almost useless to attempt any discussion of Dr. de Schweinitz' most terse and comprehensive paper.
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