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
Some such thought was in the mind of Ibershoff, who quotes Sterling and
Henderson's views that the rate of secretion depends upon and varies
with the difference in the blood pressure and the tension of the
eyeball, and that the specific gravity of the secretion increases
directly with the blood pressure and inversely with the ocular tension.
Should the blood pressure be very high, paracentesis, for example, would
apparently not be the proper procedure, and the resulting difference
produced between the blood pressure and the eye tension would cause a
rapid reformation of fluid with higher specific gravity and higher
osmotic coefficient. The proper procedure in these circumstances is
first properly to reduce the blood pressure, or what I have, quoting
Hare, ventured to call the over plus pressure.
4. _The relation of osmosis, lymphagogue activity, absorption of edema,
capillary contractility and decreased affinity of ocular colloids for
water to the reduction of increased intra-ocular tension._ We are all
familiar with the attention which was directed some years ago to the
statements coming from French clinics that the treatment of glaucoma
should include the administration of osmotic substances as adjuvants in
the reduction of increased intra-ocular tension. Particularly was this
treatment advocated by Cantonnet in the administration of daily doses of
3 grams of chlorid of sodium, preceded, of course, by a careful urinary
examination and the estimation of the amount of urine and its contained
chlorids. Carefully this dose was increased in proper circumstances to
15 grams per diem, and in Cantonnet's original paper good results were
achieved in 12 of the 17 patients so treated. I have myself experimented
somewhat, not with the administration of sodium chlorid by the mouth,
but with the introduction by the bowel of fairly large quantities of
physiologic salt solution in patients with glaucoma whose quantity of
urinary secretion was markedly below the normal, and in one or two
startling instances, which have been reported, achieved success in the
rapid reduction of the intra-ocular tension when by this technic the
urine secretion rose to the normal amount. To be sure, myotics were
also used, but these myotics were insufficient, totally so in the two
instances noted prior to the enteroclysis.
Very interesting are the observations on the subconjunctival injections
of various substances, notably the citrate of sodium, because of its
power of decreasing the affinity of ocular colloids for water. This
method of treating increased intra-ocular tension, introduced, as you
know, by Thomas and Fischer, has met with confirmation from a number of
sources in spite of the fact that Happe's experimental study failed to
confirm Fischer's observations; indeed, he even reports in several
instances a rise of tension.
Public-domain text, read in full here on John Shaqi.
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