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I believe that the two most important instillations during the twenty-four hours of the number necessary to maintain this myosis are on retiring and if possible in the very early morning, some time between two and four o'clock. Most patients can be taught to wake themselves at the proper period of time, and are little inconvenienced by this disturbance of their sleep.
We do not usually compare the statistics of early aseptic days with those of the pre-antiseptic period, and I do not think we ought to compare the statistics of myotic treatment with ordinary iridectomy any longer, but that we should wait until we can make a comparison between the results of prolonged myosis and those of an improved modern technic which establishes a permanent filtration.
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.
Usually it is taught that because of the myosis the base of the iris wedged in the angle of the anterior chamber is loosened and withdrawn, precisely as a fold in a coat is straightened by a tug on the fabric beneath it.
It is my own belief, and that of many who have studied this subject, that if, without eserin irritation, a myosis can be maintained, and if the treatment can be begun early enough, the chances of preserving vision and the field of vision are good.
In acute glaucoma, and every one knows that in this disease their action is often prompt and sometimes curative, eserin in a strength of one to four grains to the ounce may be instilled with sufficient frequency to establish myosis, and its action in this respect is enhanced if the congestion of the eye is lowered by measures to which I shall refer later.
Myosis produced by means of solutions of various drugs, a myosis followed by reduction of intra-ocular tension. Reduction of tension by means of various mechanical measures, notably massage, vibration massage and suction massage, and by means of electricity and diathermy. Indirect reduction of intra-ocular tension, accomplished by lowering general vascular pressure.
But complete experimental proof of such action is wanting, and it is probable that myosis follows a direct stimulation of the sphincter muscle fibers, aided, perhaps, by contraction of the iris vessels, although the last named effect is denied by so competent an authority as Hobart Hare. Exactly how the myotics reduce intra-ocular tension is not definitely proven.
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