Sclera

“ TUMORS OF THE CORNEA. Various tumors may grow from the cornea. Dermoid cysts may implicate the cornea and demand excision. Malignant growths demand extirpation of the eyeball.
389 WOUNDS OF THE SCLERA. Covered as it is by the bones of the orbit, and by the palpebræ the sclera is little liable to traumatic lesions. Wounds with swords, needles, nails, splinters of wood, and other sharp pointed bodies are not unknown, however, and penetration by shot is especially common in setters. Rupture from blows of clubs, beams, poles, stumps, etc., are also met with. ”

“ If the lens changed during accommodation, the iris, which rests upon it, would change also.
Fig. 30. Images on the Side of the Sclera R, rest; A, accommodation. The image in A is the larger, indicating a flattening of the side of the sclera as the eyeball elongates. My, Myopia. The eye is straining to see at the distance and the image is larger, indicating that the eyeball has elongated, resulting in a flattening of the side of the sclera. Hy, Hypermetropia. The eye is straining to see at two inches. ”

“ The sclera may become ossified posteriorly, forming an osseous sheath around the optic nerve. The pecten is a vascular comb-like membrane stretching from the nervous opticus to the crystalline lens. The choroid coat is always black. The pupil in the hen is also black and round. The iris contains striated muscular fibers. ”

“ Both eyes are almost always attacked. It more generally occurs in young people, mostly in young women. Deep scleritis is more persistent and less subject to periods of intermission than episcleritis. The deeper and more wide-spread inflammatory infiltrations of the sclera lead eventually to weakening of that coat, and cause it to yield to the intra-ocular pressure. Vision suffers from extension of the infiltration to the cornea, or from iritis with its attendant synechiae, or from anterior choroiditis, and sometimes also from secondary glaucoma. ”

“ He had been in the habit of evacuating completely the contents of the scleral cavity in cases of phlegmonous inflammation of the globe, and then—as also in excision of anterior portions of the globe in cases of anterior staphyloma or hydrophthalmia—of bringing the edges of sclera together with sutures. A very good stump, sometimes with little diminution in size of the globe, is thus obtained, which partly fills the orbital cavity and affords good support to an artificial eye. ”

“ To test the truth of this hypothesis the entire concave surface of the sclera was cauterized with pure carbolic acid immediately following evisceration in a case of extremely painful panophthalmitis consequent upon an incision, the suffering attending which had been intense for several days. ”

“ No. 43 shows a scar a little farther back, in the neighbourhood of the ora serrata; but in this case the wound appears to have healed solidly. The pigment of the underlying uveal tissue shows a marked disturbance, whilst before the specimen was cut it was observed that the sclera was pigmented in the neighbourhood of the cicatrix.
In No. 8 the wound lay in the limbus, and the solidifying scar can be traced right through the thickness of the ocular tunic and down to the mass of inflammatory exudate which surrounds the dislocated lens, and fills the angle of the anterior chamber. ”

“ Scleroderma. (Synonyms: Sclerema; Scleriasis; Dermatosclerosis; Morphœa; Keloid of Addison.)
What is scleroderma?
Scleroderma is an acute or chronic disease of the skin characterized by a localized or general, more or less diffuse, usually pigmented, rigid, stiffened, indurated or hide-bound condition.
Morphœa, by some formerly thought to be a distinct affection, is now believed to be a form of scleroderma; as typically met with it is characterized by one or more rounded, oval, or elongate, coin- to palm-sized, pinkish, or whitish ivory-looking patches. ”

“ Scleroderma is a painful and debilitating connective tissue disorder that causes hardening of the skin and can also affect several internal organs of the body. Although it can begin at any age, it usually afflicts people in their productive years. Several thousand middle-aged Americans-women more than men-have scleroderma.
In the more serious systemic form, scleroderma can not only affect the skin, joints, and muscles but also strike the gastrointestinal tract, lungs, heart, or kidneys. ”

“ In patients with scleroderma, there is an excess production of collagen, the main fibrous component of connective tissue. As a result, the formation of dense, compact tissue causes the skin to lose its elasticity. Scleroderma is also a disease of the vascular and immune systems and can impair internal organs, such as the kidneys, lungs, heart, and gastrointestinal tract.
New biomedical research findings and innovative approaches to diagnosis and treatment are essential in fighting against this multifaceted disorder. ”

“ The atrophic type of scleroderma is preceded by an edema, and from pressure-atrophy of the fat and muscles the skin of the face is strained over the bones; the lips are shortened, the gums shrink from the teeth and lead to caries, and the nostrils are compressed. The strained skin and the emotionless features (relieved only by telangiectatic striae) give the countenance a ghastly, corpse-like aspect. The etiology and pathology of this disease are quite obscure. Happily the prognosis is good, as there is a tendency to spontaneous recovery, although the convalescence may be extended. ”

“ The Sclerotic (from scleros, hard) is composed of dense, white fibrous tissue, and gives to the eyeball its firmness of figure and its white color; in front, it constitutes the part commonly called "the white of the eye." It is one of the strongest tissues in the body; it possesses very few vessels, and is not very sensitive. It affords protection to the extremely delicate interior parts of the eye; and the little muscles which effect its movements are inserted into the sclerotic a short distance behind the cornea (see Fig. 48, Y, Z) . It is perforated posteriorly to admit the optic nerve. ”

“ The eye is not affected; but in a negro the sclerotic generally appears muddy.
It appears first in small spots, either on the lips, nose, eyelids, soles, palms, or forehead, and increases peripherally—the several spots fusing together. The skin is peculiarly thin and easily irritated. Exposure to the sun readily blisters it, and after the slightest abrasion it bleeds freely. Several cases have been reported in which the specific gravity of the urine was extremely high, due to an excess of urea. ”

“ Diffuse symmetric scleroderma, or hide-bound disease, is quite rare, and presents itself in two phases: that of infiltration (more properly called hypertrophy) and atrophy, caused by shrinkage. The whole body may be involved, and each joint may be fixed as the skin over it becomes rigid. The muscles may be implicated independently of the skin, or simultaneously, and they give the resemblance of rigor mortis. The whole skin is so hard as to suggest the idea of a frozen corpse, without the coldness, the temperature being only slightly subnormal. The skin can neither be pitted nor pinched. ”

“ Approximately one in every 10,000 Americans has tuberous sclerosis, placing this malady among the more common genetic disorders. Yet it often goes unrecognized. White spots that generally appear on the skin early in life are one characteristic sign, but symptoms often take considerable time to develop and are easily misdiagnosed. ”

“ The mild or erethic form of scarlatina anginosa requires about the same treatment as scarlatina simplex. I would, however, for the sake of safety, advise a pack and bath per day, through the whole course of the disease, in the afternoon, when the fever begins to rise; and during the period of eruption, when all the symptoms increase, two and even three packs a day may be required. This depends on the increasing heat and fever, as well as on the condition of the throat. The greater the heat and fever, and the more troublesome the inflammation, the more packs. ”

“ Malignant Scarlet Fever—is characterized by an increased severity of the above symptoms; there are great prostration, delirium and sleeplessness; the rash does not always come out well; the face may be livid, and stupor and coma come on and end in death; the throat is ulcerated, and there is much difficulty in swallowing.
3. Latent Scarlet Fever—is when the disease is so mild that until the sequelae appear one is not aware of having had scarlet fever. Sore throat may be the only symptom. There is no relation between the abundance of the rash and the danger to the patient. ”

“ There are also mild cases of scarlet-fever, when little or no rash appears, and the throat is very little affected. These are the result of a particularly mild character of the epidemy, together with a peculiar condition of the skin, the desquamation of which shows that the poison went to the surface without producing the usual state of inflammation, or the rash peculiar to the disease. ”

“ It is not often, indeed, that the patient presents himself during the period of enlargement. Sometimes a perihepatitis or an unwonted tenderness in the right side compels attention during this stage, but more frequently it escapes notice. If perihepatitis occur, there will be fever, pain, and tenderness, a slight icterode hue of the skin, and possibly Jackson's76 friction sound. These symptoms, taken in conjunction with the history of the case and the obvious enlargement of the organ, will indicate the existence of the first stage of sclerosis. ”

“ By the President of the United States of America
A Proclamation Literally meaning "hard skin," scleroderma is a chronic disease that thickens and attaches the skin to underlying structures. Its cause is unknown. ”

“ My eyes became affected by sclerotitis, a severe inflammation of the sclerotic. Gradually my eyes, those most beautiful structures of the human body which manifest in such small compass the great, the unspeakable, the incomprehensible power of our Creator, grew dim. My sight was slowly but surely failing me. ”

“ Syphilis, rheumatism, gout, auto-intoxication and many other constitutional disorders are well recognized agencies which induce sclerosis in body tissues, so there can be little doubt that these conditions produce pathological sclerosis of the meshwork of the iris angle. Psychic disturbances, congested portal or renal system, hard mental or muscular work, etc., etc., induce increased pressure of the general circulation, and so simultaneously the intra-ocular pressure. ”

“ At this particular time I was attending a child who was in the last stage of scarlet fever, the desquamating stage we call it; really a peeling off of innumerable small flaky bits of skin, each of which is capable of giving scarlet fever to someone else. ”

“ I was surprised to find that young people whose health is too delicate to allow them to do many simple things, are not too delicate to go out sleighing in an open sleigh. They put hot bricks under their feet, and wrap up in furs; but the face remains exposed, and the breathing the frosty air of a winter's night, after dancing, may be easily conceived to be the cause of much of the "lung fever" of which the stranger hears. The gayest sleighing that I saw was on the day when all the schools in Boston have a holyday, and the pupils go abroad in a long procession of sleighs. ”

“ Syphilis is prone to cause small localized lesions in the nervous system. The changes in the patient’s condition, with improvements and regressions are equally characteristic of both diseases. How closely the symptomatology of neurosyphilis may simulate that of typical multiple sclerosis is shown in the next case (Lauder, 71) . When the sclerotic area of multiple sclerosis occurs in appropriate parts of the cerebrum, symptoms of mental disturbances will occur. In its histological picture multiple sclerosis is at times highly suggestive of syphilis, even showing mononucleosis and meningitis. ”

“ Scleroderma neonatorum is an induration of the skin, congenital and occurring soon after birth, and is invariably fatal. A disease somewhat analogous is edema neonatorum, which is a subcutaneous edema with induration affecting the new-born. If complete it is invariably fatal, but in a few cases in which the process has been incomplete recovery has occurred. Gerard reports recovery from a case of sclerema neonatorum in an infant five weeks old, which seemed in perfect health but for this skin-affection. ”

“ SYMPTOMS.—The development of sclerosis is usually very insidious. After some years' indulgence in spirit-drinking or affected for a length of time with the other causes of the malady, a gradual decline of vigor occurs. The complexion takes on a fawn color, stigmata slowly form on the face, there is more or less yellowness of the conjunctiva, and attacks of headache, giddiness, and even severe vertigo, are experienced. An increasing indisposition to mental effort, some hebetude of mind, and a gradually deepening despondency are felt. ”

“ CAUSES.—Disseminated sclerosis may develop as a sequel of an acute myelitis. An excellent observation of Singer,142 in which a unilateral optic-nerve atrophy of central origin occurred after recovery from an acute inflammation of the cord, proves that sclerotic foci may develop secondarily to an acute process. Westphal believes that obstruction to the circulation, both of blood and lymph, in the cord may act as a predisposing factor in the production of multiple sclerosis. ”