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
Many authors, for example, Darier, Grandclement and others, are strong
in their recommendation of adrenalin, particularly if this drug is added
to the various myotic mixtures, and yet adrenalin is certainly not
without danger in the treatment of glaucoma. McCallan has seen a number
of instances of striking increase of intra-ocular tension following this
instillation in the conjunctival sac. Harmon has had a similar
experience, as also has Senn. It is possible that in these circumstances
the solution was too strong. Should the rise of tension occur, and I
have seen it myself, it is doubtless due to the fact that this drug
dilates the pupil, which would be especially dangerous if the dilatation
should occur before contraction of the ciliary vessels; also the
narrowing of the ciliary veins by the adrenalin might by virtue of this
narrowing obstruct the gate of outflow. I have never been able to
persuade myself that, except as an adjuvant to operative work, there was
any real therapeutic value in the instillation of adrenalin.
A word in regard to the effect of general narcosis on intra-ocular
tension. Thus, Neuschuler has observed that narcosis causes an elevation
of the intra-ocular tension of from 2 to 6 degrees as measured with
Fick's tonometer. These observations were made while he was
experimenting on irritation of the sympathetic as a method of producing
increased intra-ocular tension. This is not in accord with Axenfeld's
recent observations. It is well known, this observer points out, that
after the period of excitation and muscular rigidity disappears, there
is a lowering of blood pressure in chloroform narcosis and coincidently
a sinking of the intra-ocular pressure. Not only this, the intra-ocular
tension of normal eyes during this narcosis drops several millimeters.
Only such eyes as have high hypertony, for example, in absolute
glaucoma, are unaffected during chloroform narcosis. In the light of
this observation it will be interesting to measure the tension both of
normal and glaucomatous eyes during narcosis in a large series of cases,
and if it is confirmed there will be an additional reason why in many
circumstances general narcosis is advantageous in glaucomatous patients.
Formerly I thought it was essential, if iridectomy was to be performed,
lest some sudden movement on the part of the patient might bring the
point of the knife in contact with the lens. I have rarely employed it
in corneo-scleral trephining, and yet if there is this temporary
reduction of intra-ocular pressure, it is not without a certain
therapeutic value, and the matter is mentioned as a suggestion that
additional observations along this line shall be made.
Dr. George Edmund de Schweinitz' Paper on Concerning Non-Surgical
Measures for the Reduction of Increased Intra-ocular Tension
Discussion,
NELSON MILES BLACK, M.D.,
Milwaukee.
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