DISORDERS IN RELATION TO THE EYE 77:* 



anterior chamber, and thus bringing on the acute inflammatory attack. 

 In this connection we note the persistence of pathologically increased intra- 

 ocular tension in spite of repeated iridectomies and the institution of 

 various procedures, notably that of corneoscleral trephining by Elliot, all 

 of which aim to establish a new and permanent filtration path from the 

 interior of the eye to the subconjunctival tissue spaces via filtering or 

 cystoid scars or actual fistulae. 



Glaucoma may be considered from the endocrinological point of view 

 as an exudative or hypersecretory disturbance due to sudden failure of 

 vagus tone under sympathetic irritation and hyperthyroid activity (hyper- 

 hidrosis, tachycardia, susceptibility to adrenalin and atropin, and to 

 provocative instillation of mydriatics), in hyperthyroid individuals and 

 races, age (gonad deficiency and relative hyperthyroidism of the climac- 

 teric, male or female), and emotional state (endocrin exhaustion froni 

 worry, fright, cold, hunger, exhaustion, operation), and failure of im- 

 munity (chronic infections). The similarity to an angioneurotic edema 

 on a basis of acidosis has been noted. The structural and anatomic fea- 

 tures of the globe, depending partly on topographic relations determined 

 by refraction (hyperopia), undoubtedly contribute in precipitating an 

 acute attack, but it is by no means improbable that these very factors 

 themselves may develop under endocrin dominance. The relation of ocular 

 pigment to refraction type, scleral rigidity, and tonicity of the sphincter 

 pupillae, and the combined effect of these factors on intra-ocular secre- 

 tion and tonus in individuals of various ages and endocrin disposition 

 form an interesting subject for clinical and experimental investigation. 



Encyclopedias and systems of medical ophthalmology treat of the 

 etiological relations of ocular disease to affections of the organism as a 

 whole or of individual systems such as the respiratory, the intestinal tract, 

 the cardiovascular or the nervous system, and in addition enumerate and 

 analyze the ophthalmic signs and symptoms which are of diagnostic value 

 in the interpretation of general morbid conditions and may be character- 

 ized as systems of ocular semeiotics of constitutional disease. A certain 

 amount of repetition is inevitable, depending on the correlation and 

 interplay in many cases of two or more systems with the ocular mani- 

 festations, such as nervous system and digestive tract, genito-urinary 

 and vascular tract, and so on. From the standpoint "of endocrinology 

 and pathology of metabolism it would be expedient to modify the ar- 

 rangement and classification of our clinical material and consider less 

 the anatomic or systematic grouping of the organs than their relations 

 to more basic nutritional and developmental factors in health and disease. 

 This. applies not only to local affections of the various organ systems but 

 to the border line conditions in developmental disturbances, the biological 

 variations of sexual and developmental periods or epochs, and even to 

 infections. 



