DISORDERS IN RELATION TO THE EYE T79 



I refer again in this connection to the incidence of constipation and result- 

 ing intestinal toxemia with hypothyroidism. 



Treatment of ocular rheumatism. Protection from cold and changes 

 of temperature, sharp limitation of food, removal of foci, arsenic, iodids, 

 hydrotherapy, massage. Above all, hot compresses, leeching, dionin, atro- 

 pin, catharsis, systemic alkalinization, thyroid activation. 



Diabetes. In this grave disturbance of metabolism, various ocular af- 

 fections are encountered. The commonest are disturbances of refraction 

 and accommodation, opacities of the lens and vitreous, intra-ocular or 

 retinal hemorrhages, and less frequently optic neuritis and atrophy. 



Paresis of accommodation is noted in cases of long standing, and seems 

 to depend as much on general debility as on the altered chemism of the 

 blood. A change of refraction in the direction of hyperopia or diminished 

 myopia is probably due to actual sugar content of the lens and other re- 

 fractive media (vitreous) and fluids. That there is any actual axial 

 change or decrease in the volume and contents of the globe is rendered 

 highly improbable by the rapid variations in the refraction total, the res- 

 toration to normal conditions when the sugar content of the blood was re- 

 duced, and by chemical analysis of the lens and intra-ocular fluids which 

 showed the actual presence of sugar (Leber, Knapp, Becker). 



Diabetic Cataract. This condition has been ascribed to general de- 

 bility, loss of intra-ocular fluid by dehydration, and, again, to the actual 

 presence of sugar in the fluids of the eye. The changes are generally 

 nuclear, and not infrequently unilateral. The bilateral, less common 

 form, is a uniform clouding of the more superficial cortical layers and has 

 been seen to retrogress, all of which would indicate a dependence on 

 chemical changes in the fluids which are in immediate contact with the 

 lens capsule. 



Retinal disturbances occur mainly in cases of long standing diabetes. 

 Hemorrhages and retinitis are seen. The latter shows less extensive exu- 

 dation than the form due to nephritis, while the blood effusions are often 

 massive. It is generally considered prognostically grave. Ocular palsies 

 affecting the lids and the extrinsic ocular muscles, either single or com- 

 bined, are not unusual in diabetes. They are frequently transitory. 

 Marked hypotony has been observed in diabetic coma by Riesman and 

 others. 



Albuminuria and Renal Disease. Edema of the lids is a common 

 symptom of various forms of nephritis, particularly those associated with 

 subcutaneous edema, anasarca, and dropsies. The lower lid shows a cer- 

 tain predilection by reason of the laxity of its subcutaneous cellular tissue 

 and the factor of gravity and is early affected by edemas which are often 

 evanescent or relapsing. In cases of persistent albuminuria, loss of ac- 

 commodative action is not uncommon. 



Retinal hemorrhages and actual exudative inflammation ( Bright' s 



