Eye symptoms in tabes dorsalis / by J. H. Tomlinson.

  • Tomlinson, J. H.
Date:
[1902?]
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Licence: In copyright

Credit: Eye symptoms in tabes dorsalis / by J. H. Tomlinson. 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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    little indiscretion in the use of stimulants. After, perhaps, three or four weeks, or as many months, the paralysis disappears, and may not lecur for months or even years. A second attack may appear and disappear, though it generally lasts a longer time, and frequently leaves some paresis. Kecurrent fugitive ocular paralyses rouse most forcibly the suspicion of tabes, The fleeting character of these early symptoms is puzzling. There is evidently a trophic disturbance of the nuclear cells, causing a paresis in the muscles, but in some way or other the process stops, and the cells regain their vitality. Many of the other symptoms of tabes show recessions, but none exhibit such complete abatement as the oculo-motor paralyses, unless it be the lightning pains. It may be that what is an apparent paralysis of one muscle is really an increased action, a tonic contraction, of the opposing muscle, due to an irritation of its nerve ; but the fact that ptosis is seen so frequently negatives this assumption, a& in this ease there is no opposing muscle, unless we call the orbicularis palpebrarum, innervated by the seventh, the opponent. I come now to the consideration of the optic nerve. No doubt it is often affected very early, but in the cases that I have seen there have generally been some fugitive or permanent paralyses first. A considerable number of eases of tabes show signs of optic atrophy sooner or later, and it often happens, when the disease is early characterized by this symptom, that ataxia is postponed. Probably many of the primary optic atrophies are really cases of tabes over- looked. The onset of the atrophy is gradual. One eye, as a rule, begins to fail sooner than the other. Occasionally portions only of the retina are affected, and we get scotomata, but, so far as I am aware, not central scotomata. Usually there is a gradual increasing anaesthesia of the whole retina, and, as at the best, the peripheral parts are not highly sensitive, the fields are early contracted, especi- ally for colour. I am making some investigations in the subject of colour fields, and have been led to devise a perimeter* in which coloured lights are used instead of coloured pigments, but my researches are too recent and incomplete to draw any definite conclusions as yet. The ophthalmoscopic appearances of the fundus are those of white or gray atrophy. The normal optic disc is pale-rose-coloured from the presence within the nerve of the vasse proprise. In the sclerosis of tabes there is a loss of transparency of the nerve structure; these vessels are not seen, and light falling upon the * Shown at the Ophthalmological Society, March, 1901.