GLAUCOMA 159 



atropin, or any other agent which causes a thickening of 

 the iris at this point, should not be used in cases of 

 glaucoma or in a subject predisposed to an attack, as in 

 the first instance it will only increase the trouble and 

 probably ruin the eye, and in the second instance it will 

 induce an attack. 



The simple type of glaucoma comes on very gradually, 

 is not accompanied with inflammation, and there is 

 Httle or no pain. It occurs in both eyes. The tension 

 may vary at different tunes, and often during the first 

 stage it is not recognized. As the condition advances 

 the pupils become somew^hat dilated and sluggish, the 

 cornea is clear or slightly hazy. The visual field is much 

 contracted, and the acuity of vision is greatly reduced. 

 The intra-ocular pressure is continuous and increases, 

 and, because of this, the weaker portions of the head 

 of the optic nerve give way and are pushed backward, 

 and by an ophthalmoscopic examination a deep cup- 

 ping of this portion of the nerve can be seen. The 

 retinal blood-vessels seem to be lost at the margin of 

 the disk, caused by the cupping and dipping down of 

 the vessels at this point. This cupping of the disk 

 varies in degree, according to the duration of the ten- 

 sion. If the condition is not checked, vision will ulti- 

 mately be destroyed. This simj^e type of glaucoma 

 often becomes inflammatory in character. 



The inflammatory type of glaucoma is usually ac- 

 companied with a great deal of pain, which may be 



