Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Science
Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Glaucoma
_Aqueous Humor._ The aqueous humor, as has been pointed out by
Uribe-Troncoso (Pathoginie du Glaucome 1903) contains a greatly
increased quantity of albuminoids and inorganic salts in glaucoma. In
acute glaucoma the increase of albuminoids (blood proteids) is greater
than in chronic glaucoma. The aqueous humor becomes slightly turbid in
acute attacks, coagulating more readily than the normal. The plastic
principle contained in the aqueous is rarely sufficient to cause
adhesion between the margin of the iris and the lens capsule, but the
colloid nature of the aqueous, according to Troncoso, lessens its
diffusibility and prevents its free passage into the lymph channels. The
increase in albuminoids is a consequence of congestion and venous stasis
and does not precede the attack.
_Filtration Angle._ The changes that occur in the filtration angle
before it is encroached upon by iris tissue are sclerosis of the
ligamentum pectinatum in adults to which Henderson (Trans. Ophth. Soc.
U.K. Vol. xxviii) has called our attention; the accompanying sclerosis
of the other tissues to the inner side of Schlemm's canal; and, in some
cases, the deposition of pigmented cells derived from the iris and
ciliary processes (Levinsohn) which serve to obstruct the lymph spaces.
In many of the cases of acute glaucoma and almost all of the cases of
chronic glaucoma of long standing the filtration angle becomes blocked
by the advance of the root of the iris.
_Iris._ In acute glaucoma the iris is congested and thickened. It is
pushed forward and may lie against the cornea at its periphery. When the
attack subsides, the iris falls away from the cornea. Aside from the
congestion, the primary changes that take place in the iris are
indicative of paresis of the fibers of the motor oculi that supply the
sphincter pupillae, and stimulation of the fibers from the sympathetic
producing vasomotor spasm. The long diameter of the pupil apparently
lies in the direction of the terminal vessels of the two principal
branches of each long ciliary artery which form the circulus iridis
major, where the vasomotor spasm would have the greatest effect in
lessening the blood supply. The haziness of the cornea and slight
turbidity of the aqueous contribute greatly to the apparent change in
the color of the iris. In cases of simple chronic glaucoma there is but
little evidence of edema of the iris. If the iris lies in contact with
the sclera and cornea for some time, it becomes adherent (peripheral
anterior synechia). As the disease progresses, the stroma of the iris
atrophies and contracts. There is very little evidence of small-cell
infiltration or the formation of cicatrical tissue. Numerous slits may
develop in the iris through which the fundus of the eye may be seen
(polycoria). The pigment layer does not atrophy in proportion to the
stroma of the iris; by the contraction of the stroma of the pigment
layer is doubled upon itself at the pupillary margin, forming a black
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