DISORDERS IN RELATION TO THE EYE 783 



as in Negro types. The pupil tends to be small, sluggish, and somewhat 

 spastic with little tendency to dilatation under sympathetic emotional 

 stimuli. The eye motions are slow and infrequent. There is a good deal 

 of ocular pigment. The resulting expression is that of indifference, phleg- 

 ma, impassivity, with connotations of patience. 



This type of eye has been described as the hypothyroidic eye (Jacob- 

 son) and is most exquisitely seen, raised to the pathological degree, in 

 myxedema. Within physiological limits it is dull, seemingly small, ap- 

 parently sunken, and lack-lustre. It may be summarily described as the 

 antithesis of the eye of exophthalmic goiter. 



Adrenal or gonadal dominance may, similarly, have its implications in 

 ocular morphology and topography, and sexual differences be found, 

 eventually, to depend on such variance in control. Undoubtedly the en- 

 docrin dominance has a marked influence on the rat of development of 

 the globe, and in this connection we should bear in mind that from the 

 biologic standpoint the axially myopic eye is a further developed organ 

 than the short hyperopic globe. While there is not enough systematized 

 evidence for setting up ocular types to correspond with the various en- 

 docrin categories, there does seem to be a logical basis for arranging eyes 

 in two main divisions according as they show more or less dependence 

 on the vagus or the sympathetic system in form, function, and clinical 

 reaction in its wider sense. 



Ocular Vagotonia. The clinical expression of this condition is that 

 of paralysis of the cervical sympathetic, that is, meiosis, narrowed lid 

 fissure, ptosis, enophthalmos, and anhydrosis. The tonia is easily height- 

 ened to a spasmophilia affecting not only the extrinsic ocular and lid 

 muscles but those of pupillary action and accommodation, and quite pos- 

 sibly the muscular fibers of the retinal arteries as well. This is mani- 

 fested, clinically, as tonic or clonic blepharospasm, either independent 

 or as part of various facial tics, and as relapsing retinal angiospasm 

 (intermittent claudication of the retina). The combination of symptoms 

 massed under the name of eye-strain are found by choice in this class, 

 and range from headache with or without vertigo and nausea, to various 

 reflex manifestations, themselves largely spasmophiliac. Among these we 

 may mention, in the gastro-intestinal tract, hyperacidity, hiccough, pyloro- 

 spasm, spastic constipation, and spasm of the sphincter and with a tend- 

 ency to the formation of fissures and hemorrhoids. The varieties of eye- 

 strain reflexes are endless, its manifestations, protean, appearing in 

 the respiratory tract as nervous, dry or useless, cough, as pseudo-asthma 

 and as laryngeal spasm with aphonia ; in the domain of neurology, in the 

 form of various tics or habit spasms, from torticollis to clownism. Even 

 the psychical sphere may contribute its quota of symptoms in the form 

 of emotional spasms which are preponderantly akin to dislike, jealousy, 

 suspicion, anxiety, or morbid worry. 



