DISOKDERS IN RELATION TO THE EYE 791 



Ocular Affections of Pituitary Origin 



Minor pituitary disturbances are frequently associated with head- 

 ache, transitory disturbances of vision, or evanescent defects in the visual 

 field, some of which assume the clinical form of scintillating scotoma, 

 amaurosis partialis fugax, or transitory hemianopsia with a dazzling 

 character and irregular zigzag outline of the scotoma, the so-called forti- 

 fication scotoma (teichopsia). Vascular disturbances alone are sufficient 

 to cause such symptoms after sexual excesses or too free-carbohydrate in- 

 gestion in fatigue, menstruation anomalies, and other conditions which 

 disturb the balance between the adrenals and the pituitary, and this 

 etiology explains the, frequently temporary character of the visual dis- 

 turbances and their frequent immediate relief by restoratives such as 

 rest, the local application of heat to the brow or orbits, strong coffee, or on 

 the other hand by brisk purgation, or derivation. Crowding of the 

 pituitary body against the sellar wall by actual hypertrophy may cause 

 repeated or continuous headache with visual field disturbances which con- 

 tinue until in some cases the syndrome is finally brought to an end by a 

 breaking down of the bony wall of the sella at its least resistant point, 

 allowing free expansion of the growth. In some cases the general mani- 

 festations were those of acromegaly, in others the adiposo-genital syn- 

 drome of Froehlich, from which Timme concludes that the X-ray pic- 

 ture of a small or occluded sella with erosion does not allow us to draw 

 definite conclusions as to the clinical somatic type to be expected, as the 

 point of least resistance of the sella, rather than the pituitary gland 

 itself, is the determining factor. Where enlargement takes place laterally, 

 there is a tendency to encroach on the cavernous sinus and cause pres- 

 sure on the vessels (internal carotid, central artery of the retina), and 

 nerves, notably those supplying the extrinsic ocular muscles and the oph- 

 thalmic division of the fifth, causing attacks of ophthalmoplegic migraine 

 characterized by visual disturbances, pain, and single or combined ocular 

 palsies. Changes in the posterior clinoid processes and marked reduction 

 in size of the sella were noted in cretins by Timme who advises the ad- 

 ministration of pituitary gland extract in addition to thyroid so gen- 

 erally given with effect only up to a certain point. The incidence of 

 obstinate headache in status thymicolymphaticus is also attributed largely 

 to the pituitary (Timme). 



Ocular Disturbances in Hypophyseal Disease. (Bitemporal limita- 

 tion, later hemmnopsia.) The visual symptoms, consisting in typical 

 defects in the fields for color and form, with the underlying optic atrophy 

 or retrobulbar neuritis are to be attributed to the effects of local pres- 

 sure, and in lesser degree to coincident increase in intracranial tension. 

 The coincidence in some cases of an endocrin factor is indicated by the 



