SYMPTOMS AND COURSE.- The condition generally first noticed is a bright reflex from the interior of the eye. There is no pain or redness and the anterior part of the eye is normal. When seen early there is noticed, with the ophthalmoscope, a white or yellowish-red tumor with either a nodulated or smooth surface, and usually blood-vessels are seen coursing over its surface. The retina is generally detached and the lens and vitreous are clear. As the tumor increases the iris and lens become pushed forward and the anterior chamber shallow. The growth continues to increase, causing distension of the eye; pain sets in, the coasts, of the eye give way and the tumor appears externally. It becomes ulcerated, bleed easily and exudes a bloody foetid discharge. Its growth is rapid and soon involves the orbit and temporal regions and presents a huge vascular mass. The choroid and optic nerve become involved first the medullary portion of the nerve and then the sheath. This causes a thickening of the nerve, and, in this way, extension to the brain. Metastasis may take place to other parts of the body the patient becomes cachectic and death from exhaustion or brain disease is the final result.
CAUSES.- Glioma of the retina is either congenital or occurs in infants. It usually appears under the age of ten and but one case, that of Mervill, Trans. American Ophthal. Soc., vol. 2, p. 364. in a man aged twenty-one is on record where it occurred after the sixteenth year. Usually but one eye is involved, although both maybe implicated simultaneously or in succession.
DIAGNOSIS.- Purulent choroiditis so closely simulates glioma as to be spoken of sometimes as pseudo-glioma. The differential diagnosis depends on the history and local appearances. In choroiditis there is the history of previous illness meningitis or cerebro-spinal meningitis and often an inflammation of the eye will have been noticed. These two symptoms are the essential diagnostic points although in choroiditis the mass is apt to be more yellowish in appearance and the tension minus; while in glioma the tension is rarely low and may be increased even before glaucomatous symptoms become evident.
PROGNOSIS.- In glioma the prognosis is always bad, although numerous cases are recorded where the eye has been removed early with no recurrence of the growth but it is altogether hopeless, if left to its own course. The most common method of death is by an extension along the optic nerve to the brain. If a relapse occurs after enucleation a fatal issue is most certain. Noyes (loc. cit.) says. ” A single case is given in which the patient survived after removal of secondary tumor.” To this may be added a case reported by Dr. Geo. S. Norton, Journ. Ophthal., Otol. and Laryngol., vol. 2, April, 1890. Where the secondary growth appeared about two and one-half months after the enucleation, with the previous symptoms of constitutional disturbance. This was removed and the fluid extract of Red clover blossoms (Ceanothus Americana) administered. This patient was last seen by the writer ten years later, at which time she was in perfect health and with no signs of any return of the growth.
TREATMENT.- This should be by operation, and, if the enucleation is made in the very early stage there is a fair chance of eradicating the disease, which is at this time purely local. In enucleation for glioma it is always best to remove as long a portion of the optic nerve as possible. If the operation is made in the glaucomatous or later stages of the disease, all the contents of the orbit should be removed. After the growth has perforated the eyeball and becomes of a fungus appearance, operation can only be considered for relief of the pain as it is then too late to offer any hope of preserving the life.
The use of Red Clover blossoms to prevent the recurrence of glioma after operation seem from the case reported by French and Norton (loc. cit.) to be worthy of a trial in all cases of this malignant disease. So far as we have been able to find no other medication has ever proved of any value.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.