Cases illustrating various types of scotoma in the visual field : portion of a lecture on "The visual field as a factor in diagnosis" delivered before the J. M. Da Costa Medical Society of the Jefferson Medical College / by G. E. De Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1894?]
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Licence: Public Domain Mark

Credit: Cases illustrating various types of scotoma in the visual field : portion of a lecture on "The visual field as a factor in diagnosis" delivered before the J. M. Da Costa Medical Society of the Jefferson Medical College / by G. E. De Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    In Case II. the scotoma is a typically annular one, and, taken into consideration with the ophthalmoscopic appearances of the disk, may be explained by an interstitial neuritis affecting the intermediate fibres of the nerve, without seriously encroaching upon the peripheral and macular bundles. Swan M. Burnett,1 in an interesting article on ring scotoma, directs attention to Bunge's assertion that the papillo-macular bundles supply the central area of the retina for an oval space 20 degrees in the horizontal direction and 10 degrees in the vertical, an area which in one of his cases approximately remained intact, being a counterpart of the central scotoma in circumscribed retro-bulbar neuritis. It will be noted that the same space, not greatly differing from Bunge's descrip- tion, is unaffected in my case, and, therefore, the theory as to the prob- able localization of the lesion, already recorded, receives support. This line of reasoning is also utilized by Burnett, to explain the scotoma in his patient's visual field. The ordinary explanation of ring scotoma, viz., choroidal lesion or degenerative retinal disease, is not suited to the present instance. Alto- gether, the symptoms point to optic nerve-lesion, although the peculiar head-tremor is suggestive of central disease. At present, however, our knowledge is too defective to speculate upon the nature and situation of an affection which would bear an etiological relation to an association of these two phenomena. HOMONYMOUS LEFT LOWER QUADRANT SCOTOMA ; LATER RIGHT LATERAL HEMIANOPSIA; STILL LATER RESTORATION OF UPPER RIGHT QUADRANT; AND, FINALLY, RESTORATION OF FIELDS, BUT DEVELOPMENT OF LARGE RING SCOTOMA. Case III.—L. J., aged sixty-four, born in America, came for treat- ment April 11, 1888, complaining of inability to read accurately, of a bluish-black spot in each field of vision, and of attacks of subjective vertigo. His health had usually been sound, though he was subject to bilious attacks. Venereal infection denied ; family history good ; mental faculties normal; no anaesthesia; K. J. minus ; urine negative. Vision in each eye with proper correction, £; no paresis of ocular muscles; pupillary reflexes normal. The field of vision is depicted in Figs. 6 and 7,—viz., an absolute scotoma in left lower quadrant of each eye; in the remainder of the quadrant there was loss of color- sense, but preservation of faint form-sense; color perception was nor- mal in the preserved areas. Transactions American Ophthalmology Society, 1887.