DISOKDEKS IN RELATION TO THE EYE 775 



of fat ; drug eruptions and conjunctivitis and dermatitis of the lids in 

 atropin idiosyncrasy. 



Ocular affections and Eye Symptoms in Disorders of Metabolism. 

 With an abnormal chemical constitution of the blood as a direct or in- 

 direct result of disordered metabolism, changes are found in the ocular 

 tissues which are quite similar to those observed in other parts of the 

 body and which are of importance first on account of the accessibility of 

 the eye to minute clinical examination which gives it diagnostic impor- 

 tance in general disease, and further because of the prognostic and func- 

 tional significance of even slight disturbances of circulation, to say noth- 

 ing of severer accidents such as hemorrhages in the light-perceptive tissues 

 (choroid, retina) or into the transparent media. 



Ocular hemorrhages into the conjunctiva or deep seated extravasations 

 in retina or vitreous are not uncommon in the various forms of anemia and 

 profuse hemorrhages in other organs (uterus, stomach) and are not infre- 

 quently followed by retinal or neuroretinal inflammation or optic atrophy. 



Similar disturbances are frequent in pernicious anemia and in leu- 

 kemia with multiple hemorrhages or actual retinitis. In various meta- 

 bolic disorders attended by entrance, into the blood, of pigment or other 

 constituents of the bile, icteric discoloration of scleral conjunctiva is a 

 striking symptom. This is the more easily detected as the underlying 

 sclera is of about equal whiteness in blondes and brunettes, so that the 

 yellowish discoloration appears in the eyes much sooner and in slighter 

 degrees than in the skin or mucous membranes. Here, too, hemorrhages 

 are not infrequent, especially in the retina, vitreous, and anterior cham- 

 ber. The pus of a coincident conjunctivitis (gonorrhea, purulent ca- 

 tarrh) is often distinctly icteric but the tears are never stained in this 

 way. 



In this connection we may refer to transitory myopia due to an in- 

 creased refraction of the aqueous, similar to that observed in diabetes and 

 Bright's disease, owing to the presence of biliary products and possibly 

 albumin. Xanthopsia in chronic hepatic disease has been attributed to 

 icteric discoloration of the vitreous. 



Ophthalmia Hepatica. Under this heading, an ocular complication of 

 chronic disease of the liver and biliary passages has been described which 

 is marked by typical hemeralopia and disturbances of vision due to pig- 

 ment epithelial changes in the choroid and retina similar to those de- 

 scribed in chorioretinitis pigmentosa (q. v.). Concentric contraction of 

 the field is commonly, and blue blindness occasionally, seen. Epithelial 

 xerosis of the conjunctiva and cornea and keratomalacia, again with the 

 typical hemeralopia, have been noted in these cases, and as an expres- 

 sion of nutritional disturbances in the eye due to a lack of bile or to the 

 presence of bile by-products which like bile acids are known to dissolve 

 the visual purple. Observations on this subject date back to the earliest 



