Eye Symptoms of Venous Infections

Eye Symptoms of Venous Infections

EDITORIALS tients. The perfecting of a unified and efficient ophthalmologic staff strengthens the specialty in the school. All these things affect bo...

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EDITORIALS

tients. The perfecting of a unified and efficient ophthalmologic staff strengthens the specialty in the school. All these things affect both the instruc­ tors and the students. The opinions of the latter are largely influenced by the attitude of the former; so if the former respect ophthalmology and think it a desirable field, that also will be the reaction of the student. Most important of all is it that the layman for his own good should think highly of the ophthalmic profession; and from whom does the layman get his ideas of medicine but from the family physi­ cian, and the student of today is the family physician of tomorrow. L. T. P. E Y E S Y M P T O M S OF V E N O U S INFECTIONS. A young man with acute inflamma­ tion of the middle ear, under treatment for several weeks by the best oto-ophthalmologists in two cities, died of brain abscess, without having been ex­ amined with an ophthalmoscope, or having his visual fields taken. Venous thrombosis is nearly always due to infection of the wall of the vein. The possibility of such an in­ fection should be borne in mind and its effects looked for. Leucocytosis in the blood stream and ophthalmic symptoms, especially papilledema, are the definite evidences of such infection that declare the basic pathologic con­ dition to be dealt with. Failure to look for the only signs that can be relied upon with confidence has been the reason for many failures to make a diagnosis. The cases that have been thrust upon the attention of the ophthalmologist by exophthalmos, diplopia, or diminished vision, constiture only a minority of the infections of the Λ'enous sinuses within the cra­ nium. Only a routine search for facts that are discovered by special tests and examinations, brings to the patient the resources of modern medicine. The book of Eagleton, recently no­ ticed (v. 9, p. 913), emphasizes the large number of infections of the cra­ nial venous sinuses, that are not forced

on the attention of the ophthalmolo­ gist by exophthalmos and impaired sight. The sudden swelling of the tistues of the lids and orbit points to an­ terior infection of the cavernous sinus, as from injury, or suppuration of the nose, face, or about the teeth, orbits or nasal sinuses. A larger number of such infections are not proclaimed by sud­ den or complete venous obstruction, and have heretofore escaped notice, or any special investigation. There are portions of the intracra­ nial venous channels that may be in­ fected without causing eye symptoms, or only cause them thru involvement of the cavernous sinus. But there are also venous channels, as those of the orbit, lids, nose and other parts of the face, that may cause ocu ar disturb­ ances without involvement of the cav­ ernous sinus. The important points to be understood and appreciated with regard to venous infections are that they have the same essential pathology in different parts; and, when estab­ lished at one point in the venous sys­ tem, are likely to extend to other parts of it. Apart from the relatively few cases of "marasmic thrombosis," the impor­ tant fact about all such lesions is that they are of bacterial origin, and must be combatted by the measures that are effective against infections. Vaccine and serum treatments must be tried, in the effort to improve the prognosis that has heretofore been unfavorable. Local drainage, which is very effective for a single local lesion, is less reliable when the infection causing a throm­ bophlebitis has come to the walls of the veins thru the blood stream. This applies whether the infection is in the cavernous sinus, or in the veins of the orbit. The exact diagnosis as to the locality of the thrombosis is less im­ portant than the knowledge of its cause. Special examination may give certainty as to the presence of such a lesion, and may show its location and progress toward death or recovery; but treatment must deal rather with the general cause, affecting also other parts of the body.

EDITORIALS

In any case diagnosis must precede treatment, and where the case is o b ­ scure every diagnostic resource should be utilized. This is only possible if the diseased condition is borne in mind; and looked for in cases that remain obscure until the appropriate method of examination is resorted to. These special examinations may yield noth­ ing in many cases. But they are worth trying in all, because of the positive information and certainty they alone can give in a few important diseases. E.J.

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light sense in early glaucoma, and the evaluation of visual efficiency. There is one paper by Dr. Lancaster of Boston, and its discussion, that are out of the usual lines of scientific pro­ ceedings ; a sort of stock taking of the present effectiveness of the common methods for ophthalmic education. It is based on "An analysis of the marks obtained in the different subjects, by the candidates for the certificate of the American Board for Ophthalmic Ex­ aminations." This analysis shows that of the four major subjects, pathology had the largest number of failures and of very low marks, next comes external BOOK NOTICES. diseases of the eye, then ophthalmo­ Transactions of the American Ophscopy, while refraction showed the thalmological Society, Sixty-sec­ smallest number of failures. A strik­ ond Annual Meeting, 1926. Cloth, 8vo, 397 pages, 28 plates, one in ing fact, confirmed by several in dis­ colors, and 57 other illustrations. cussion, was the improvement in quali­ Philadelphia, published by the So­ fications that has been going on thru the ten years these examinations have ciety. Beside the four major Perhaps the most striking thing been held. branches, mentioned above, the figures about this volume is the page headed "In Memoriam" and bearing the fol­ .are given on the four other branches in which practical examinations are lowing names, arranged in the order given. These are the ocular muscles, in which they became members of the Society: Thomas R. Pooley, 1869; C. perimetry, relation of ophthalmic to therapeutics. S. Merrill, 1874; Walter B. Johnson, general diseases and These examinations are raising the 1892; Alexander Duane, 1902; S. Lewis Ziegler, 1903; Lee M. Francis, 1913; standards of fitness for ophthalmic Marcus Feingold, 1920. It must be practice; and to have the mass of oph­ remembered that William M. Sweet, thalmologists know more about them will help. for several years the active member of the Publication Committee, has ended The three membership theses are his labors since the completion of this upon subjects of scientific and practical volume. Six of the plates reproduce importance: Congenital Aniridia, Me­ fine photographic portraits of the de­ tastatic Carcinoma of the Choroid and ceased members. These with the ac­ of the Iris; and Luetic Interstitial companying sketches of their lives and Keratitis of Traumatic Origin. Each characters, give this volume positive of these has a bibliography appended, historic interest. thru which the student is given a The Transactions include 26 papers broad grasp of the literature that will help to a good understanding of the that were presented at the annual meeting, with the discussions elicited; subjects. A s an Appendix to the vol­ ume, the Report of the Committee on and three communications that were Compensation for Eye Injuries is re­ accepted as theses, from candidates for printed from the Proceedings of the membership in the Society. The bulk of these papers and the discussions, are House of Delegates of the American Medical Association. The index to the concerned with clinical studies and re­ volume makes it a practical book of ports of cases. There are also special E. J. studies of convergence fatigue, the reference.