Some recent theories regarding the pathogeny of sympathetic ophthalmia, viewed from a macroscopic standpoint / by Samuel Theobald.

  • Theobald, Samuel, 1846-1930.
Date:
[1884]
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Credit: Some recent theories regarding the pathogeny of sympathetic ophthalmia, viewed from a macroscopic standpoint / by Samuel Theobald. 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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    have already spoken, giving it quite a different interpreta- tion. The first and most obvious objection to this doctrine (which Leber himself appreciates) is, that sympathetic in- flammation almost always begins in the anterior portion of the uveal tract, and not in the region of the optic nerve, as should be the case if this view were correct. Leber, indeed, suggests that neuritis may always be present without being recognized, owing to the turbidity of the vitreous humor ; but, as the neuritis should manifest itself first, it ought to be more frequently observed before the inflammatory process has extended to the uvell coat and rendered the media cloudy. Indeed, if there beany truth in Leber's other theory, that papillitis, or choked disc, is dependent upon the pres- ence of a phlogogenic fluid in the optic-nerve intervaginal space,1 then, if his view of the etiology of sympathetic ophthalmia were correct, it would seem that just this con- dition of a well-marked neuritis should be the most frequent- ly met with and the most characteristic feature of the dis- ease ; but, as has been said, papillitis, or choked disc, appears to be the one form of sympathetic inflammation which has not been recorded. Moreover, if papillitis and sympathetic ophthalmitis resemble each other as closely in their etiology as Leber would have us believe, it seems not impertinent to inquire why they should differ so absolutely in their clinical history. Again, it may be said, that if the description usually given by anatomists of the intervaginal space of the optic nerve be correct, namely, that it ends abruptly in the sclerotic tissue about the optic-nerve en- trance, being cut off from the deeper tissues of the eye by the interposition of the pial sheath, which at this point turns out to blend with the inner third of the sclerotic, the dural sheath being lost in the outer two thirds, it is diffi- cult to understand how the inflammatory process spreads hence to the ciliary body and iris. Some authorities claim that there are lymph-spaces in the lamina cribrosa which communicate directly with the intervaginal space, but this Leber, himself, has denied. The occurrence of dropsy of the 1 Op.cit., p. 52 et scq. Trans. Seventh International Med. Congress, (1881), vol. iii., p. 55.