Haemorrhage into the Vitreous.-Usually occurs from the vessels of the choroid, retina or ciliary body, and generally results from an injury, such as a blow or wound of the eye or concussion of the skull. The haemorrhage may be partial or entirely fill the vitreous, being so dense as to wholly obscure the red reflex of the fundus, and then may often be seen as a dark red mass by the oblique illumination. There is partial or total blindness, which may have come on gradually or suddenly. Spontaneous haemorrhage into the vitreous and retina have been seen to occur. The haemorrhage will often be wholly or partially absorbed in the course of a few weeks, but more frequently floating opacities remain behind.
Foreign Bodies in the Vitreous.-Usually in injury the foreign body will become lodged in the coats of the eye, although it may penetrate into the vitreous. It most generally passes in through the cornea, wounding the iris and lens, or lens alone, and more often becomes lodged either in the iris or lens. In some cases the foreign body will penetrate by the way of the sclera, in which it may be lodged. It may drop into the vitreous, or, passing through the vitreous, become lodged in the coats of the eye at the opposite side, or, penetrating these, may become embedded in the tissues of the orbit. A foreign body within the vitreous usually becomes within a few hours surrounded by a cloudy opacity which may become organized, forming a cyst wall around it, but as a rule, instead of becoming encysted, it will result in inflammation, which may lead to abscess, or, remaining localized, result in detachment of the retina; or, by an extension of the inflammation, cause panophthalmitis.
In some cases the foreign body will remain visible in the vitreous for some time without becoming fixed or encysted, and may lead, when in this condition, to either glaucoma or sympathetic ophthalmia. The entrance of the foreign body is usually accompanied by haemorrhage from the choroidal vessels. The most frequent foreign bodies are chips of iron, steel, glass and shot-the latter are always more favorable than are other foreign substances. In diagnosing foreign bodies in the vitreous, the history of the injury will be the first clue. We may then find a corneal would or scar, with evidences of injury of the iris or lens, by the ophthalmoscope. If there is not too great haziness of the lens or vitreous, we may often see the foreign body itself, if a piece of iron or steel, of a bluish or greenish while color with a glistening border.
TREATMENT.-Removal of the foreign body by means of the electro-magnet has been successfully done in many cases. The magnet is, of course, only applicable to particles of iron or steel, yet, as these substances form the large majority of cases, its use has been the means of saving many eyes that, previous to its employment, would have been lost. If seen shortly after the injury, before the wound is closed, the opening, if in the sclera, is somewhat enlarged, so that the substance will not be brushed off when the magnet is withdrawn. The needle of the magnet is then introduced through the wound to as near the foreign body as possible. When the substance can be located by the ophthalmoscope the needle can be passed directly to it. If, however, it cannot be seen, the appearance of the would will often indicate the direction to be followed and a certain amount of exploratory excursions are permissible. If the penetration has been through the cornea and lens, the lens should first be removed and the needle inserted through the corneal opening. Haab Bericht. d. Ophthal. Gesellschaft zu Heidelberg, 1892. uses a very powerful magnet applied to the surface of the eyeball, and many successful results have been reported from this method. After the wound has closed, if the substance can be discerned with the ophthalmoscope, an opening may be made in the sclera by means of a meridional cut through the equatorial part of the sclera and the magnet used. If, however, the substance cannot be discerned, it is better to delay opening the sclera until the eye gives evidence of well developed inflammatory symptoms, as in rare instances it becomes encapsulated and may be allowed to remain, if the patient is made to thoroughly understand the importance of an immediate enucleation of the eye upon the first evidence of sympathetic irritation. Failing in the attempt to remove the foreign body, if the injury has been sufficient to destroy vision, enucleation or evisceration may be employed at once.
The inflammation arising from injuries must be subdued by ice compresses, the instillation of Atropine, and proper internal medication. The remedies will usually be Aconite, Arnica, Calendula, Hamamelis, Ledum or Rhus.
Cysticercus in the Vitreous.-The presence of a parasite in the eye is of extremely rare occurrence in this country, but is quite frequently met with in North Germany. Its origin is between the choroid and retina. It causes detachment of the retina, and finally perforates it, enters the vitreous and sooner or later causes an irido-cyclitis, with inflammatory changes which end in destruction of the eye. It has a dumb-bell shape, is iridescent, and has a peristaltic motion. The treatment is to remove the cysticercus.
Persistent Hyaloid Artery.-The hyaloid artery is an extension from the central artery of the retina which in the embryo runs from the papilla to the lens and furnishes the nourishment of the lens. Obliteration of this artery is usually complete before the termination of foetal life, but sometimes it fails and some vestige of the artery remains. With the ophthalmoscope a somewhat tortuous cord may be seen, which may extend from the disc forward to the lens or merely as a rudimentary strand attached either to the disc or lens, and in some instances it has been seen to contain blood. This condition is often found associated with persistent pupillary membrane or other foetal abnormalities. The vision is often but slightly affected.
Detachment of the Vitreous.-The vitreous may become detached from the retina by traumatism, or haemorrhages, as a result of exudation in choroiditis and from intra-ocular growths. It is always of serious import from its tendency, by dragging upon the retina, to cause a detachment of that membrane. It is considered by some authorities to be a forerunner of nearly all detachments of the retina. Galezowski diagnosed detachment by a semicircular gray rim at the border of the optic disc, but there appears to be no constant signs by which it can be diagnosed with certainty.
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.