OCULAR REFLEX NEUROSES



Under peculiar reflex symptoms may here be mentioned the case of a lady with myopic astigmatism who felt a severe pain run down her right leg every time she tried to read more than a few minutes.

In the above consideration of the resulting sensory neuroses, above given, as pain, neuralgia, headache, etc., we should remember, as Erb well states it, that pain is a common sensation that belongs, not to a peculiar kind, but only to a certain degree of sensation, and it thus has no specific quality. It is only a question of intensity; hence pain is only the aggravation of normal sensations, and this is the chief difference between a physiological reflex and an abnormal or reflex neuroses. The sensation of pain depends upon two factor, its intensity and individual susceptibility.

The various forms of reflex neuroses, which may result from optical anomalies, will illustrate the different reflex pathways through which perverted nerve may be exhibited.

While the attention of the ophthalmologist is principally directed to the various forms of reflex neurosis originating in the eyes, he should carefully keep in mind that, in keeping with the laws of reflex nerve action, irritation of any character, having origin in my organ or at any part of the body remote or near the eyes, may be transmitted back to and affect the eyes through the same pathways which the first-mentioned efferent neurosis travelled. Indeed, many of the most obstinate and annoying cases of eye trouble we meet can only be remedied by the discovery and mastery of the remote causes which produce them. The eye is in a state of responsive sympathy with every organ and region of the body.

Tabes dorsalis or allied diseases are accompanied by contracted pupils and at times by paralysis of the eye muscles. Paresis of the occulo motorius and abducens occur in the early stages of locomotor ataxia.

In seventy cases of locomotor ataxia reported by Graniger Stewart (ef. Med. W., 1882) there were 20 cases of squint; 3 of ptosis; 4 diplopia, without manifest squint; 7 of myosis; 4 difference in papillary diameter; 8 with Argyll-Robertson pupil, etc.

On the other hand, irritation of the cilio-spinal region will often associated with partial mydriasis and optic nerve congestion, while paresis or paralysis off the cervical sympathetic will produce myosis as well as partial ptosis. This is through the sympathetic system of nerves. According to Hensen and Volckers, the papillary fibres of the sympathetic have the cord at the upper dorsal and lower cervical vertebrae, going through the superior cervical ganglion and entering the carotid plexus.

They then pass through the ciliary ganglion in the orbit. The whole of the fibres do not take this course, because it is found that when the ciliary ganglion is extirpated, irritation of the trunk of the sympathetic will still dilate the pupil. The ophthalmic branch of the fifth nerve, and probably other nerves connecting with the inner eye, also furnish channels of access for other sympathetic fibres. The partial ptosis is caused by paresis or paralysis of the sympathetic, which sends motor fibres to the musculi palpebrales. This form of partial ptosis is not uncommon in women, and is frequently associated with reflexes from the uterine or ovarian system.

Hystero-neuroses form a special and frequently met with group. It is noteworthy, however, that the severity of the uterine disease does not predicate the presence or absence, the severity or the mildness of the reflex. Authority tells us that structural diseases of the uterus and its appendages are not so apt to be followed by reflex phenomena, as functional troubles.

In this very interesting discussion of “Visual Disturbances and Uterine Disease,” A Mooren (A. f. A. vol. x.) declares, from his large experience, that there is no part of the eye which (either from a physiological or pathological point of view) is beyond the influence of the uterine system. He assigns the reflex theory as the direct cause.

The suppression of menstruation has frequently produced eye complications. McKay (Jour. Med. Sciences, 1882,) gives twelve cases of ocular affections from suppressed menstruation, numbering among them choked disc, diplopia, asthenopia, defective vision in some, etc.; while M.F. Comes (Am. Med. Herald. Oct., 1882,) gives four cases of menstrual amblyopia, varying from slight loss of vision to almost total blindness, deep seated pains in eyes, with burning stinging, etc.-all of which were restored after menstruation had been re-established.

Sexual excesses, especially masturbation, are frequent causes of reflex ocular trouble. The latter is a prolific cause of much irritation, and it it generally very difficult to trace, especially in females. It is frequent cause of spasm of the accommodation, hyperaemia of the funds and optic disc, obstinate neuralgic pains in and about the eyes, and in some cases paresis of the accommodation.

Connected with hysteria, that general neurosis of the whole nervous system, there are frequent and various forms of eye complications, embracing partial or complete amblyopia, hemiopia, scotoma, phosphenes, floating clouds, myosis, mydriasis, ptosis, photophobia, spasm or paresis of the accommodation, neuralgic pains, etc., all of which are purely reflex ocular neuroses, a part of the general neurosis.

Orificial irritation are frequent causes of reflex troubles. This includes haemorrhoidal and other and diseases, phymosis, stricture of the urethra, or cervix uteri-all of which are, without question, frequent causes. Recent current medical literature is filled with cases fully illustrating this.

Intestinal irritation, either from inflammation or from worms, has been followed by ocular reactions. Both of these conditions may produce similar eye reflexes, such as temporary strabismus, diplopia, myosis or mydriasis, ptosis or wide-open eyelids. Many remarkable cases have been reported from time to time. Lawrence (Am Ed., 1854, p. 607,) gives case of a child, seven years old, who had intolerable paroxysms of pain in left eye, which was entirely relieved by purgatives, bringing away a coral bead, which had been swallowed.

M. Wishart gives a case of complete amaurosis of the left eye, in a boy nine years old, of four months’ duration, who made immediate recovery after free purgative.

Another case is given of a boy, eight years old, who could not see large print, who was rapidly restored after turpentine enemata brought away quantities of worms.

In a recent case of my own, a young man of twenty-six, who had a very persistent and annoying diplopia, causing vertigo and disagreeable head symptoms, recovered promptly after pressing several years of tape-worm.

There are many cases, similar to those related, on record.

The great trifacial nerve is very intimately connected with all parts of the visual apparatus, both directly and indirectly through the sympathetic nerves and the ciliary ganglion. From this we might expect that all the necessary conditions to favor frequent and varied forms of ocular reflex neuroses were present- and such is the case.

Many authentic cases of defective vision following irritation of the fifth nerve, have been reported. McKenzie (Am. Ed., 1855, p. 997,) gives a case of a man who had a small tumor on the crown of the head, which had been ten years coming. It was not painful or sensitive to touch. He had much headache, and quite a defective vision. it proved to be a cartilaginous cyst, filled with a yellowish fluid. Its removal restored his vision and remedied his headaches.

Within the past year a patient of mine had a tumor, size of a filbert, about one-half an inch above the supra-orbital foramen of the left eye. It had been gradually developing for some years, and the vision of that eye had been as gradually growing less and less. The removal of this growth perfectly restored the sight.

Many cases of partial or nearly total loss of vision, caused by diseased teeth, have been published. I discussed this topic in a contribution, “The Eye-tooth and the Eye,” in the Chicago Medical Investigator (July, 1875), and gave then the accepted explanation for it, which is that it is a reflex-neurosis through the ciliary ganglion and the other sympathetic connections of the great trifacial nerve. Since then a number of interesting cases have come under my observation. One case is well worthy of comment.

A lady had a large cavity in the left upper bicuspid tooth. The diseased contents were thoroughly excavated and removed, and the nerve was killed by a dentist. The tooth was filled with gold. A month or two afterward, the vision of the left eye began to fail, growing less and less as the weeks went by. The tooth was not sensitive, but the gum at one side of it seemed painful to pressure.

The tooth was extracted, and the sight was rapidly restored. Examination of the tooth showed that in the filling of it the thin side wall had been perforated at one point, and a little plug of gold had been forced through it, extending about one-tenth of an inch outside, and pressed against the wall of the socket; and this had set up the reflex-neurosis, through the well known pathways, to the seeing-nerve.

James A Campbell