New England College of Optometry - Scope Yearbook (Boston, MA)

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THE SCOPE Syimapautlhetiio Uveitis or Sympathetic Uphthalmia By JOHN F. BRENNAN, '32. Sympathetic Uveitis is a much dreaded pathological condition, in which serious inflammation attacks the sound eye after an injury to the other eye. The occurrence of this condition, thankfully, has become fewer in recent years, due to the increased skill in the treatment of perforating wounds, particularly in the ap- plication of antiseptic principles. A perforated woundutherefore, especially if a foreign body is retained within the eye, is therefore a source of great anxiety. Sympathetic Uveitis, primarily results from a perforating wound, one such as is caused by a foreign body, which remains within the eye for some period of time. Wouiatls in the ciliary region, iris or lens, the so-called dangerous zone, and leading to its in- carceration in the scar have always been considered dangerous. lf suppuration supervenes, Sympathetic Uveitis is very unlikely to follow, hence perforating ulcers very seldom fol- low it. The occurrence of this pathological condition takes place at any age, but children are particularly susceptible. It usually begins from four to eight weeks after the injury to the first eye has taken place. Very rarely it occurs much sooner, but the onset may be delayed for many months or even years. There is always an Iridocyclitis in the primarily infected eye. Usually it is a plastic type, which has been set up by the injury and has not subsided in the course of three or four weeks. Instead of quieting down, the ciliary injection remains and there is lacryma- tion and tenderness to pressure. In the sympathizing eye there is almost always found a plastic Iridocyclitis due to other causes. In cases known to have a predisposition to the condition, the first sign may be the presence of precipitates on the back of the cornea. When fully developed all the signs and symptoms of Iridocyclitis are present, varying in degree to the severity of the case. Tension, although difficult to determine on account of the tenderness, is moderately raised. It may then pass into the condition of lowered tension with gradual shrinking of the globe. In most cases a ring synechia forms and secondary glaucoma supervenes. Sympathetic Uveitis sometimes takes two or more years to run its course. The pathology of Sympathetic Uveitis is unknown. The microscopic examination in both the primary infected eye and the sympathizing eye are the same. It is probable that the condition in the sympathizing eye is a Proliferative Uveitis fFuchsj and that the infection, which is pathogenic for the eye alone, is conveyed through the blood stream to the sympathizing eye. QRoemerj. In the earliest stages examined, there are nodular aggregations of small round cells scattered throughout the uveal tract. Evidence which has accumulated in modern times tend to show that Sympathetic Uveitis is an infective disease and is least liable to occur in otherwise likely cases if the wound or retained foreign body is sterile. On the other hand it rarely occurs if actual suppuration has taken place in the primarily infected eye. It is therefore more likely to occur from retention of shot, a chip of stone, glass, etc., than from a particle of hot steel, probably because the latter is sterile. Various theories have been brought forward to explain the occurrence of inflam- mation in the sympathizing eye. It has been suggested that severe inflammation in one eye produces a tendency to ciliary irritation in the other eye by some occult means con- nected with their anatomical and physiological symmetry, but there is no evidence to support this conjecture, The most probable theory is that there is a specific organism, which has as yet escaped observation possibly because it is so small, as to be ultravisible l26l

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THE SCOPE BE-38 EEE BE-33 B922 EE H B533 The right to a prolit for service well rendered is not sufiiciently enjoyed in the optical field. The adoption of ORTHOGON lenses provides a legitimate and etiiective method ofse- curing a more adequate proht with- out increasing fixed charges and overhead expenses. ORTHOGOJVS lllc' rzlmifzzble in SOFT LITE also. CULUNHAL CU5lP'llillCAlL C00 HPQGIKDHRH QDHRAKTTHEHD SUCCESSORS TO G. Rl. Smith Optical Company Michaels, Bohiing Gibbs, lnc. Boston New York City Silhert Optical Company, lnc. Rochester lZ5l QQSEQMQSQEMQWQSQEQEEE A ai-:si lngvxl 6 Q LQ E was E 5 :W Q -ogggggsggr ,Ii E 32EfwUEw?E22 Q5 Q MS W Q5 gg ..Og..,,-:fDO..:.:-Qf.4. , rixl 32'E.g2Q5Lgi?l'i'5'H3, ?EHQ o--2-QD' ..,.,pDCC . Sgffl 2.3253252232 Z Z :Wi sfiiwii-:Sie 5 -:i':,'5n?i...CS-g'Uf-TI -,3:J'f,, Qgfqggggg, ti F Z Ei LQ w f .' :r at 2 W : H Q uv C23 :veiq E U2 te? P: E Q UD LQ EQQQSQQMQQEEZMQMQQMQEQE EE QEEEQSQQEQZQEQQ E H 93? 523 if 8553? 5: BEE? Qs E738 BE-33 BE-'33 53 Q 95 E55 FQ? EE

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THE SCOPE by the microscope, but one which causes general infection through the blood stream. It may be conjectured that the organism is harmless to other organs of the body and that it finds suitable nidus only in the other eye and even then only under favorable circum- stances. The treatment of Sympathetic Uveitis is a most difficult problem. Primarily treat- ment must be prophylactic. ln every case of a perforated wound, with or without reten- tion of a foreign body the question of enucleation of the eye on account of the danger to its fellow arises. It may be assumed that Sympathetic .Uveitis never occurs after the excision of an injured eye, unless it has already commenced before the excision. There- fore, excision is a positive safeguard against the disease. Secondary treatment for Sym- pathetic Iridocyclitis is administered. Prognosis in this disease is very unfavorable, due to the great inflammation of the entire uveal tract. thus affecting nutritional apparatus of the eye, causing shrinkage and Hnally atrophy of the entire structures of the eyeball. Referenre: Parsons, Henderson, Fuchsg Dr. Sloane's lectures at the Mass. School of Op- tometry. Uflth Bffl U'iM5.rj701ll DR. HENRY SCHURGIN BaoeKToN,Mass C01llpfll!lflllf gf DR. SYDNEY D. ADAMS NVOBURN, MASS. Cowpfmlffltf j5'o1z1 DR. JOSEPH I. PASCAL Beit ffirhar Q' DR. RALPH GREEN BOS'I'ON,MASS. C0mpl1'mfl1l.r DR. ALBERT E. SLOANE Colllpfilllfzllf ty' RHODES BROTHERS RETAIL GROCERS 170 MASS. AVE. BOSTON, MASS. Coaarcr TREATMENT Patient-Well, doc, you sure kept your promise when you said you'd have me walking in a month. The Doctor fglowingj - Well, well, thats fine. Patient-Yes, I had to sell my car when I got your bill. OPTOMETRIC STUDENT I'm glad you're so impressed, dear, by all these explanations I have given you about banking and currency, remarked Clarence Baker. Yes, darling. It seems wonderful that anybody could know as much as you do about money without having any. Plefzfe ptifiwzize om' fzdz'e1'Iife1'r-they nuke om' liltle paper pofrible. Tluzma yon. l27l