In the above brief examples of various forms of ocular reflex neuroses, no attempt has been made to explain why the reflexes should be so varied in their nature; why the phenomenon is at one time sensor, at another motor, than functional and again organic; for, as mentioned before, there does not seem to be any known law regulating the direction which the reflex may take. They may thus be manifested as.
I.-Sensor. II.-Motor. III.-Functional. IV.-Organic.
Under sensor reflex neuroses may be grouped all forms of abnormal or perverted sensations-hyperaesthesia-anaesthesia.
Under motor reflexes will be included all forms of spasmodic action (tonic, clonic, spastic), paralysis or paresis.
Under functional reflex ocular neuroses, will be numbered all interference with the proper nutrition of the eye, or its vaso-motor supply, affecting as a result either the seeing nerve, retina, dioptric media, accommodation apparatus; or the proper support of any of the other eye tissues.
Closely related to this last heading is the reflex neuroses, which may result in organic changes; anaemia, hyperaemia, inflammation tissue or anatomical changes, hyperplasia, neoplastic formations, degenerative processes, hypertrophy or atrophy. Eye literature is full of examples of the above statements.
McKenzie relates a case of a man, aged 45, with an old discharging ulcer on his leg, which was suppressed by his getting wet. This was followed by blindness, in fourteen days afterward. The ulcer was restored and vision then returned. The same authority tells us that Beer claimed to have cured twenty such amaurotic patients, by restoring suppressed ulcerations. Such conditions can only be explained by reflex sympathy from the sentient surfaces to the cerebro-spinal centre, transferred to the sympathetic system, and through this to the optic nerves and retinal expansion, or their brain centres.
A. Moore has discussed this question in his paper, “Influence of the Skin and its Diseases upon the Eye.”.
An important additional heading should be likewise mentioned, which while distinct from the others, is very markedly influenced by any one or all of the above subdivisions given. It may be introduced under the term psychic, or the influence of ocular neuroses upon the brain centres proper, which may result in illusions, aberrations, chorea, epileptoid seizures, vertigo and even insanity. Both optical anomalies and heterophoria have been followed by such results.
Experiment has demonstrated, that section or paralysis of the cervical sympathetic will be followed by hypotony, and that irritation of the same nerve will produce the reverse effect, hypertony; thus proving conclusively, that tension of the eye is largely influenced, if not entirely regulated by the sympathetic nerve. The well-known fact that the irritation of the fifth nerve may cause increased T. and its paralysis a reduced T., does not disprove it, for the is latter effect may be explained by the intimate relationship and reflex blending of these nerves, brought about thoroughly the ciliary ganglion.
Hence, since it is thus proved that T. of the eyes may be increased by irritation of the sympathetic nerves, and decreased by its partial or total paralysis, and since the nutrition of the eye itself is largely influenced by the same sympathetic; and finally, since the sympathetic may be irritated by reflex action, from other nerves, it would seem reasonable to assume that glaucoma is merely a reflex neurosis, arising from a continued irritation of the sympathetic nerves, it would seem reasonable to assume that glaucoma is merely a reflex neurosis, arising from a continued irritation of the sympathetic nerves, connected with the eye, which irritation, as we have seen, may have origin in any part of the body near or remote from the eyes.
Indeed the frequency with which we find glaucoma associated with other bodily diseases, gives emphasis to this proposition. I have been struck with the frequency of the coexistence of rheumatism and similar disorders, and glaucoma. It has followed sudden shock, fright, fear and even joy. The suddenness of its onset, at times again points strongly to its reflex nervous origin.
Following this same line of thought in the light of the phenomena presented, it is difficult for me to believe, that sympathetic ophthalmia is likewise a reflex neuroses, from a diseased eye, to similar and corresponding parts in the other eye. This, to me, seems more reasonable, and in accordance with facts and conditions, than the strained effort to explain it by any microbian meanderings or contiguous inflammatory transmission, or through the lymphatics.
In the discussion of this subject I have realized thoroughly its immensity, and the utter impossibility of describing and including all the numerous phenomena connected with it, in the limits of a paper on such an occasion as this. My effort has been, to bring out, for discussion, in a brief and simple way, some of the most salient points connected with the topic, and to offer a certain few debatable propositions for discussion.
A brief notice of a new book, The Relation of the Visual Organ and its Diseases to the Other Diseases of the Body and its Organs, by Dr. Max Knies, has recently attracted my attention. I very much regret my inability to secure a copy of it, for it is, no doubt, a most valuable contribution to the subject I have endeavored to introduce.
