The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
=The Eye.=--Of the manifestations of syphilis in particular organs the
eye sometimes suffers severely. _Iritis_ is the most common and serious
manifestations of constitutional syphilis. It has been estimated that
nearly 60 per cent. of all cases of iritis are due to this cause. It
may occur in two months after the primary sore; it is usually acute,
and rarely begins in both eyes at the same time, but may involve one
after the other. The ciliary body is frequently associated in the
lesion, and _iridocyclitis_ occurs. It commences with congestion of
the conjunctiva, photophobia, and lacrymation. The pain is not always
severe. Inspection of the iris will show beads of lymph, a small pupil,
with loss of contractility, or the dull iris may appear infiltrated and
inflexible. The pain in some cases is extreme. Where treatment has been
only partially effective relapses are common. The greatest danger to be
feared is formation of adhesions between the anterior surface of the
lens and the margin of the pupil, _i. e._, anterior synechiæ. These are
detrimental, and serve as the cause of many irritations.
The treatment of these affections is constitutional; locally solutions
of atropine of sufficient strength to ensure dilatation of the pupil
should be used, not only to relieve the pain, but to carry the
margin of the pupil from the central portion of the lens and prevent
adhesions. The patients should be kept in the dark because of their
photophobia. Atropine may be substituted by duboisine if the former
tends to produce congestion. Leeches applied to the temples will also
give relief from pain.
The _cornea_ is often affected by a deposit on its posterior surface
of particles of debris, which give it a punctate appearance known
as keratitis punctata. It also becomes the seat of opacities which
materially interfere with vision, and prove only partially amenable to
treatment. Lesions of the cornea are frequent in hereditary syphilis.
_Retinitis_ and _choroiditis_, of either acute or chronic type, are
the most common syphilitic lesions of the fundus. They are usually
associated and involve both eyes. They come on so insidiously that they
are often far advanced when first discovered. The lesions consist of
patches of exudation and areas of atrophy, accompanied by some haziness
in the vitreous. Vision is affected in proportion to the area involved.
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