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Updated: June 3, 2025
Dilatation and tortuosity of the anterior ciliary veins are due apparently to excessive flow of blood through them on account of the abnormally small amount carried off by the venae vorticosae. In the stage of degeneration, ectasae of the sclera occur most frequently near the equator of the globe. Spontaneous rupture may take place. Anterior Chamber. The anterior chamber is shallow, as a rule.
The eye was atrophied, and on examination a piece of stone was seen projecting from it directly between the lids. The visible portion was 1/4 inch long, and the end in the shrunken eye was evidently longer than the end protruding. The sclera was incised, and, after fourteen years' duration in the eye, the stone was removed.
While Lagrange holds that it is necessary to open the anterior chamber, Bettremieux thinks that a removal of but a portion of the thickness of the sclera suffices.
His procedure is as follows: After raising a flap of conjunctiva from the neighborhood of the limbus a medium sized needle, curved and flattened towards its point and firmly grasped in a needle holder, is thrust superficially into the sclera tangentially to the upper edge of the cornea, so as to become fixed in the capsule of the eyeball.
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.
The excavation of the disc progresses slowly and is due in part to stretching the fibers of the lamina cribrosa pressing this structure outward, and partly to atrophy and disappearance of the nerve tissue and much of the vascular tissues in the nerve head. The displacement backward of the lamina cribrosa may cause that structure to lie behind the outer surface of the sclera.
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 chief lymph stream flows from the posterior chamber past the margin of the lens, through the zonula of Zinn, beneath the iris, through the pupil into the anterior chamber, thence through the tissue at the junction of the iris and sclera into the circular canal of Schlemm and from this space into the external lymph channels.
The eyes may remain open for such long periods of time that the conjunctiva and sclera may become quite dry and ulcerate. In these extreme cases there is, of course, no response to verbal commands. What is more striking, no reaction appears to pin pricks, so that it seems as if consciousness of pain were lost. This deep torpor does not usually persist indefinitely.
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