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
_Physiologic Action._ Concerning the ocular, physiologic action of the
two chief alkaloids respectively of Calabar Bean and of Jaborandi, there
still exists difference of opinion. It has always been easy to attribute
the myotic action of these drugs, or at least, of eserin, to their
stimulant action on the peripheral ends of the oculo-motor, thus causing
sphincter contraction, and to a depressing action on the sympathetic
fibers, thus causing removal of the action of the dilatator of the iris.
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. 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withdrawn, precisely as a fold in a coat is straightened by a tug on the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. Experiments, however, for example, by E. E.
Henderson, have shown that the rate of filtration in an eye with
artificially raised pressure is considerably larger when it is under the
influence of eserin than it is when under the influence of atropin; that
is by the contraction of the pupil the iris-surface filtration is
increased and consequently the pressure is reduced. We all know that
Thomas Henderson maintains that the results of iridectomy are beneficial
because the raw edges of the coloboma, which do not cicatrize, permit
access of the aqueous to the iris veins, and that myotics, inasmuch as
they contract the pupil, open the iris crypts and therefore act, less
efficiently, perhaps, but act none the less like an iridectomy. The
normal intra-ocular pressure is uninfluenced by myotics because this
pressure represents the lowest circulatory pressure in the eye, and
further contact between aqueous and veins cannot reduce it below this
level, another point which is made by Thomas Henderson in support of his
contention.
The clinical fact remains that either by mechanical means, as it were,
in the liberation of a plugged filtering angle, or by the increasing of
iris-surface filtration, the myotics markedly reduce the abnormal
intra-ocular pressure.
Public-domain text, read in full here on John Shaqi.
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