Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson.

  • Robertson, J. Argyll.
Date:
1844
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Licence: Public Domain Mark

Credit: Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    liuinouv ; for it is found that, in proportion as the opaque reflect- ing body advances towards the cornea, it loses its metaUic histrc. I have observed also, that, in the non-malignant affection, although the pupil was dilated, it was regular in form, and the texture and colour of the iris were not altered. In some instances, also, vision was not entirely lost, whereas, in malignant diseases, total blindness, I believe, always exists. I am at present attend- ing a lady, twenty-six years of age, Avhose eye presents the lus- trous metallic appearance. It is dependent on effusion of blood into the hyaloid membrane, which apparently Avas caused by a sudden fright. Instantaneous blindness of the affected eye fol- lowed. The effusion is gradually being absorbed, and she can now distuiguish large objects. The pupil is fully but equally dilated, and there is no change in the colour or texture of the iris. The sclerotic retains its natural appearance, and no enlarged or tortuous vessels are seen on the conjunctiva. The importance of a correct diagnosis in such cases is sufficiently evident. The operations which have been performed for the cure of the medullary carcinoma in the eye have almost, without excep- tion, proved unsuccessful, tlic disease returning within the period of two years from the date of the operation. So great, indeed, has been the want of success, that it may almost be a question in how far we are justified in continuing to operate in this disease. In one case out of the live of excision for the cure of medullary carcinoma situated within the eyeball, the disease did not re- appear. The patient, John Graham, fifty-six years of age (Fig. 16), in passing through a wood in the dark, received a severe blow in the right eye by running against a decayed branch of a tree. The blow was so severe that he fell to the ground insensible. He speedily recovered from this state, but vision was entirely lost in that eye, and has continued so ever since the accident. The inflammation which followed yielded to leeching and warm fomentations, and the eye recovered its ori- ginal appearance, with the exception of a dilated state of the pupil. The accident occurred in the autumn of 1818 ; in the month of June 1824 he began to suffer from a feeling of fulness and distention of the eyeball, and an occasional throbbing pain in the temple and forehead. In August it was first observed that the pupil Iwd assumed a yelloAvish metallic colour. In October the eyeball began to project from its socket. In January 1825 he placed himself under my care. On examining the eye the cornea was opaque, and the vessels of the conjunctiva en- larged and tortuous. The form of the eyeball Avas irrcgulnr, and the cornea much ir.ore conical than natural. On its centre was a deep ragged ulcer passing through all its laminro, and the bottom of the ulcer was occupied by a soft pultaceous mass, through which the pi'obc passed readily into the interior of the eyeball. Mis hoaltli was failing from constant suffering and