A peculiar case of herpes zoster ophthalmicus, serous iritis, or 'ophthalmo-neuritis' / by George M. Gould.

  • Gould, George Milbrey, 1848-1922.
Date:
1888
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Licence: Public Domain Mark

Credit: A peculiar case of herpes zoster ophthalmicus, serous iritis, or 'ophthalmo-neuritis' / by George M. Gould. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Lastly, we see why pilocarpine would relieve the tension of the nerves and adjacent parts by withdrawing the serous exudate of the perineuritis, and the powerful action of antipyrine and quinine would contribute to reinstate the interrupted and normal trans- mission of the innervation, thus bringing about the sudden and happy relief experi- enced by the patient. To avoid circum- locution, I have therefore coined the term, ophthalmo-tieiiritis, as indicative at once of the organ affected and the pathology of the disease, and I hazard the query, if many cases of so-called serous iritis are not in fact due to a peripheral neuritis ? The anomalous and inexplicable mysteries of that peculiar affection would thus be brought to show their causal relations and their analogies with other facts and other affections. PART II.—POSTSCRIPT. The preceding pages here stand as they were written two days before my patient was to return to work. I leave them thus in order the better to bring into view the diffi- culties of diagnosis, and the lessons derivable from them. I had up to Aug. 19th kept my patient from returning to work because I had in daily remembrance a case of facial paralysis with ocular complications that I had treated one year previously, in which there was an almost identical history of exposure to a cold draught of air after great heat, and in which several weeks after apparent recovery there was extensive herpetic eruption over the pes anserinus. Reasoning upon analogy, I was awaiting herpes zoster ophthalmicus, if my diagnosis ofophthalmo-neuritis were correct. The disease, it will be remembered, had been continuous for thirty-seven days, when there was a crisis and, following pilocarpine, etc., sudden relief, with an eighteen days’ convalescence. I had about concluded that there would be no herpes zoster to put the seal of certainty upon my diagnosis, when it came so suddenly and so severely that my pleasure at the proof was speedily for- gotten in anxiety lest the eye was to be lost after all. In twenty-four hours, lines of herpetic vesicles, as if burned with a red-hot wire, suddenly appeared along the side of the nose opposite the inner canthus, extend- ing toward the supra-orbital foramen and across the upper eyelid. With this there was lighted up a plastic iritis, with circum- corneal injection, cloudy aqueous, etc. There was no herpes cornese or conjunc- tivse. As there was no pain at all with all this, the patient did not come to me for some twenty hours after the eruption began appearing, and yet in this time the iris border had already formed resisting attach- ments to the lens-capsule. These I suc- ceeded in breaking away. Other slight lines of herpes subsequently appeared on the lower lid and at the outer canthus. The four weeks of convalescence that followed were interrupted by a relapse in which a slight iritis appeared, and a muco-purulent con- junctivitis, with an inflammation of the skin of the lids and parts about the eye, supplied by the first branch of the fifth nerve. There was no positive eruption, though there was great congestion, the skin at one time assuming a smooth, shining appearance, and later a parched, wrinkled look. Under careful treatment this within a month at last passed away. Herpes zoster ophthalmicus !—This was the masked enemy I had been fighting for fifty-five days ! According to the existing classification and nomenclature, the affection must be called by this name. And yet what a commentary upon our pathology and symptomatology, to call a disease after a slight, unimportant, painless, widely-sepa- rated and superficial skin symptom, that appears after the real disease has been going on for fifty-five days ! I have, in review of the literature of herpes zoster ophthalmicus, found one case in which the herpetic symp- tom did not appear for three months. That, from the analogy of one case of