MANIFESTATIONS OF GOUT IN THE ORGANS OF SPECIAL SENSE.
Disorders of the eye are not infrequently encountered in gout simi lar to those seen in rheumatism. Many authors have failed to dis tinguish clearly between them for the reason that their symptoms are nearly identical, though their causes may differ. There are also dis eases of the eye occurring in gouty subjects that are only indirectly due to arthritism. Thus a gouty patient may have black specks float ing in the field of vision, or may seem to be looking through a fog, or he may be embarrassed by central scotomata. He may even become suddenly blind; and, on ophthalmoscopic examination, a retinal hem orrhage may be discovered. This is due to the state of arterial disease that accompanies interstitial nephritis, so that gout is not the direct cause of these visual accidents, but is their remote antecedent. In like manner it may be the indirect and remote cause of certain cases of arcus senilis, atrophy of the optic nerve, and progressive loss of sight in elderly patients who have suffered long with chronic gout. Yet other elderly subjects who have never had experience of gout may be afflicted in the same way, illustrating the well-known pathological fact that very similar diseases may be excited by widely different causes.
Among the disorders of the eye that are directly connected with acute gout may be mentioned a variety of conjunctivitis that fre quently precedes an articular inflammation. It sometimes so far antedates the attack that it must be reckoned among the prodromal symptoms; in other cases it accompanies the onset of the pain and swelling in the joint. It is characterized by an abrupt and ap parently causeless beginning; there is considerable pain, redness and swelling of the conjunctiva, usually without much photophobia, and a rather copious watery discharge. So soon as the joint becomes in flamed, these symptoms all subside, and disappear in the course of twenty-four hours. The earlier attacks leave no trace; but if often repeated, the sclerotic vessels become permanently dilated, and a chronic blepharitis may be established.
Garrod and others have observed, in a number of instances, the formation of genuine tophi in the conjunctiva and sclerotic coat of the eye. These rare deposits are not found during the acute attacks of gout, but are usually the result of gradual and unnoticed infil tration.
In like manner, inflammatory attacks affecting the eye are more common during the course of irregular gout than in acute forms of the disease. They occur, like other erratic manifestations, with an abrupt commencement, a rather violent course, and a sudden termina tion whenever articular or visceral crises begin. They usually involve the iris and the clioroid, and sometimes invade the sclerotic. When this coat is inflamed an injected zone is visible through the trans parent conjunctiva, more conspicuous than elsewhere around the in sertions of the ocular muscles.
Iritis and irido-choroiditis are more frequent than sclerotitis; they are, in fact, the most common of the gouty inflammations of the eye. They are usually encountered amoug•the members of arthritic families, who have gouty deposits in the joints, ears, and elsewhere; they are liable to periodical recurrence, especially in the spring of the year, like regular articular gout; they frequently occur indepen dently of other manifestations, but sometimes they follow the out break of inflammation in the joints. Despite the efforts of eminent ophthalmologists to distinguish the gouty iritis from other varieties of the disease, no such distinction can be made. There are no pa thognomouic symptoms, and from the clinical point of view there is no difference between arthritic iritis and the varieties of the malady that are excited by rheumatism or syphilis. But in the gouty forms of iritis there is a greater tendency to paroxysmal exacerbation of the symptoms, as the disease progresses by fits and starts. These ex acerbations are accompanied by serous and fibrinous exudations that greatly increase the liability to posterior synechia with all its train of deleterious consequences.