Ophthalmomalacia

OPHTHALMOMALACIA, ophthalmomalacia (from Greek ophthalmos—eye and malakos—soft) (syn. phthisis bulbi essentialis), an extremely rare disease, the main feature of which is a sharp drop in intraocular pressure in an eye that is in all other respects completely healthy. The etiology of the disease is very obscure. The most probable cause should be considered a lesion of the cervical sympathetic nerve, since the disease has some similarity to Horner's symptom complex, which develops as a result of paralysis of this nerve. Sometimes the occasion for the development of ophthalmomalacia is damage to the eye itself (including operations) or the cervical sympathetic nerve. The disease can manifest in an acute or chronic form, and an intermittent course is sometimes observed. In the acute form, which develops very rapidly, besides a sharp drop in pressure, there is a clear decrease in the size of the eyeball, mild ciliary injection, lacrimation, photophobia, a sensation of pressure in the eye, and sometimes neuralgic pains. With a very strong drop in pressure, indentations appear on the walls of the eyeball along the course of the rectus muscles, and a slight wrinkling develops in the cornea due to the formation of folds in Descemet's membrane. The eye sinks slightly into the orbit (enophthalmos). In the chronic form, the phenomena are not so pronounced, and sometimes the matter is limited only to hypotonia and a certain decrease in the size of the eye. Other phenomena of paresis or paralysis of the sympathetic nerve are often added—ptosis, miosis, redness and subsequently pallor of the skin of the face on the corresponding half, and others. In the intermittent form, the drop in pressure and other related phenomena appear in attacks which, repeating at certain intervals, last from several hours to several days, and then give way to a normal state. Ophthalmomalacia must be strictly distinguished from the hypotonia that develops as a result of any diseases (most often iridocyclitis) or injuries to the eye, as well as the hypotonia observed in congenital microphthalmos. Anatomically, there are no definite data in view of the scarcity of material. In one case, Schmidt-Rimpler found a decrease in the volume of the eyeball—6 cm³ against 7.5 cm³ on the other side. The course of acute and intermittent ophthalmomalacia is generally favorable, since for the most part it is cured without consequences for the function of the organ. The chronic form can exist for a long time, sometimes for life. Treatment: galvanization of the cervical sympathetic nerve, a general strengthening regimen, antineuralgic remedies. Locally—atropine, warmth. Quinine is especially recommended both internally and locally in the form of drops.

V. Odintsov.