The Retina and Optic Nerve.
Retina.—Hemorrhage into the retina may arise from a number of causes, thus it is found in leukemia, the pernicious anemias, purpura, and scurvy, and is often the first evidence of chronic nephritis. It may take place during parturition, though it most frequently occurs after the menopause. Vision is more or less impaired, and if the hemorrhage be superficial, an ophthalmoscopic examination reveals redness and swelling of the eye-ground, while deeper hues reveal the characteristic flame-shaped redness. White opacities are due to fatty degeneration of the retina or to extravasation of leukocytes.
Retinitis.—There are three principal forms,—(i) albumin-uric, (2) syphilitic, and (3) pigmentary.
Albuminuric retinitis is found in from fifteen to twenty-five per cent of all cases of chronic nephritis, especially in the interstitial form. Not infrequently retinal changes occur before albumin is present to suggest nephritis. According to Gowers, three forms exist,—a degenerative, a hemorrhagic, and an inflammatory form. In the first, degeneration with retinal changes, there may be but slight alteration in the disk, or white patches of fatty degeneration are dotted over the fundus; in the hemorrhagic form, there may be but slight evidence of inflammation, and the hemorrhage assumes a striated or feathery aspect; in the inflammatory form, there is much swelling of the retina and obscuration of the disk.
Syphilitic Retinitis.—This form of retinitis occurs occasionally in the late stages of acquired syphilis, and is not so frequently seen as choroiditis or chorio-retinitis.
Opalescent patches are seen upon the retina, and the vitreous humor assumes a turbid condition. Failing vision is the first symptom to attract attention to this condition.
Pigmentary Retinitis.—This is usually seen in young adults and suggests inherited syphilis. Not infrequently two or more members of a family are thus afflicted. Pigmentary material is deposited along the course of the retinal arteries; as the deposit increases, there is a progressive loss of vision.
Treatment.—The general practitioner will not have many cases to treat, as the patient will consult an oculist. The few that he will treat, should be handled in the same rational manner as characterize diseases in general; namely, meet the conditions, as far as possible, by specific remedies.
Belladonna for evidence of congestion of the retina; gelsemium where there is determination of blood to the eye, and it is in an active excited condition. Antisyphilitics when indicated, such as phytolacca, echinacea, stillingia, the iodids, and kindred remedies. Although we are not to expect too much in the curative action of internal medication, we may at least retard the progressive course of the disease.