THE THEORIES OF ORIGIN OF HYDROPHTHALMIA

A survey of the foregoing summary of the morbid anatomy of early specimens reveals two types of disorder in the ocular tissues. Firstly, one detects developmental defects due to an arrested or an otherwise faulty growth. Secondly, undoubted evidences of inflammatory changes are found.

It is difficult to divide with certainty all the changes into one or other of these types. The distension of the globe has led in most cases to so much distortion that it is not always possible to visualise the state of the affected tissues before they were stretched and affected by late or secondary degeneration and even inflammatory changes. One must be constantly asking whether the signs of inflammation in the iris, for example, are due to intra-uterine infection or to a relatively late postnatal process that developed with ease in an already over-stretched and disordered structure.

Even when one has decided that the main changes in a certain globe are such that one can label them as congenital anomalies, one has not definitely excluded them as ravages of intra-uterine infection.

One must remember that, even in such true examples of the developmental type as Seefelder specimens II and III, traces of an almost vanished intra-uterine iridocyclitis were found. This suggests that the initial cause was inflammation, and that the direct cause of hydrophthalmia was the developmental defect that resulted from the inflammatory state. Therefore, when we state that a certain specimen is of the developmental type we do not deny an initial role to an earlier inflammation. We simply mean the direct cause was an arrested or defective development of some structure. Possibly, however, in such an eye the nitration apparatus, though developmentally defective, was adequate until a mild attack of inflammation developed. Then the albuminous aqueous blocked the restricted means of escape and hydrophthalmia ensued.

The finding of such traces of iridocyclitis and the more obvious signs of secondary iridocyclitis tends to obscure the picture and make the recognition of the direct cause of hypertension very difficult.