Gout, with a section on ocular disease in the goutyLlewellyn, Llewellyn J. (Llewellyn Jones)
Science
Gout, with a section on ocular disease in the gouty
Llewellyn, Llewellyn J. (Llewellyn Jones)
Eye -- Diseases; Gout
Among the many and indiscriminate diseases of the eye which have been
considered to be due to gout are included blepharitis, conjunctivitis,
episcleritis, scleritis, orbital cellulitis, neuro-retinitis,
retro-bulbar neuritis, optic neuritis, optic atrophy, iritis, cyclitis,
choroiditis, glaucoma and retinal hæmorrhage. Truly an all-embracing
rather than an eclectic list, a medley of diseases without any melody.
_Evidence of Gout in the Eye._—When we inquire what is the evidence which
justifies the belief that gout causes ocular disease we find little more
than a traditional hypothesis inherited in a long line of succession
from the Fathers of Medicine. Nevertheless the opinion that there is a
connection is widespread, not only in Europe, but also in America.
In considering this relationship we cannot overlook the effects of the
diathesis on other viscera. How in these is a diagnosis of gouty origin
arrived at? It would appear that the assumption of an irregular form of
gout is based upon the following observations:—
(i.) That it sometimes happens that an undoubted attack of
articular gout aborts and is followed by symptoms referable
to a grave visceral disorder, _e.g._, gout in the stomach
(retrocedent gout);
(ii.) That sometimes the converse occurs, viz., that an attack
of visceral disorder may suddenly be replaced by an acute
articular manifestation;
(iii.) That such visceral derangements may alternate, not
only with articular, but also with other, such as cutaneous,
outbreaks;
(iv.) That eye disease has been known to wax and wane in unison
with concurrent arthritic gouty manifestations;
(v.) That occasionally in gouty people an attack of iritis of
sudden onset in the night has been followed by remission of the
symptoms in the day[47];
(vi.) That visceral symptoms in the gouty are anomalous and
inexplicable on any other basis;
(vii.) That the treatment usually advocated for gout has a
favourable influence.
_Deposition of Urates._—Two cases are recorded by Garrod in which there
was a deposit of urates in the sclera. These instances do not appear
to have been confirmed by other observers, and they may be regarded as
exceptional cases, occurring, it should be noted, in the outer envelope
of the eye. But though these tophaceous deposits may occur in the sclera
and in the eyelid, they have never been known to invade the intrinsic
structures, such as the iris or ocular media. The eye, in fact, is on all
fours with the sites of urates elsewhere—deposition occurs in parts of
relatively low vitality.
Although urates are not found within the eye, there is in other morbid
ocular conditions quite frequently a deposition of foreign matter, such
as alien crystals, of varied description. For instance:—
In the _sclera_ on rare occasions we find osteomatous degeneration.
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